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CITY OF SANTA ANA <br /> Risk Management a division of Human Resources <br /> Managing Risk through Awareness and Action ,i r"" <br /> AFFIDAVIT OF EXEMPTION FOR AUTOMOBILE LIABILITY INSURANCE <br /> I, Robert Coleman, Director of Nonprofit Services ("Representative"),attest that 1 am an authorized <br /> (Name and Title of Vendor Representative) <br /> OneOC,fiscal sponsor of OC Environmental Justice Education Fund(OCEJ) <br /> representative of ("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 N/A <br /> ("A <br /> greement") provide Investing in the Artist Grant Program <br /> �eement )to P ("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 employees, consultants,representatives, and agents will not use and/or drive <br /> any Company owned/rented/leased/borrowed vehicles to perform Services to,for,or on <br /> behalf of City of Santa Ana. <br /> — f-any-Aime_it_is_foundrhat_Company is not adhering to any and/or all of the statements in this <br /> document and does not maintain the minimum automobile 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 /> 12, Qj(QAA^a% — +- — <br /> Signature Date <br /> Robert Coleman <br /> Print Name <br /> Director of Nonprofit Services <br /> Title <br /> 714.597.8961 and rcoleman@oneoc.org <br /> Contact Information,i.e.,Telephone Number and/or Email Address <br /> Affidavit of Exemption for Automobile Liability Insurance 11.12.2024 <br />