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CITY OF SANTA ANA �� <br /> Risk Management a division of Human Resources <br /> Managing Risk through Awareness and Action "'�'� '`"r <br /> AFFIDAVIT OF EXEMPTION FOR PROFESSIONAL LIABILITY INSURANCE <br /> 1, SC'0>Z 011 ou sAg j _ &PV rp r l I !v►Q vICL 1 ev ("Representative"),attest that I am an authorized <br /> (Name and Title of Vendor Representative) <br /> representative of TV Prp 6edy— Di C ("Company"),and <br /> (Consultant/Company Name) <br /> possess the authority to legally bind Company. <br /> In my capacity as Representative of Company,I represent and confirm the following,as relates to the <br /> agreement between Company and City of Santa Ana,agreement number R r-f Zy J 6 <br /> ("Agreement")to provide fah-C& I( ,�P@ (fitvdNC.�©v. ,f �cC��i�l 5'�.f+/ CNS("Services"): <br /> (Services to be provided under agreement/contract) <br /> During the course and scope of Company's agreement with the City of Santa Ana, <br /> Company will not use the services of an expert necessitating professional liability/errors <br /> &omissions liability insurance coverage in the performance of Services to,for,or on <br /> behalf of City of Santa Ana. <br /> If at any time it is found that Company is not adhering to any and/or all of the statements in this <br /> document and does not maintain the minimum professional liability insurance coverage as <br /> required in the Agreement,it will be considered a breach of Agreement rendering the Agreement <br /> null and void and Company will be fully liable for any and all damages. <br /> c E)a - 25 <br /> Signature Date <br /> fit, �0v�y�/c�. <br /> Print Name <br /> 690(2,rGti) M"CI, ev- <br /> Title <br /> Contact Information,i.e.,Tefephone Number and/or Email Address <br /> Affidavit of Exemption for Professional Liability Insurance 11.12.2024 <br />