Laserfiche WebLink
CITY OF SANTA ANA . <br /> Risk Management a division of Human Resources It-'" <br /> Managing Risk through Awareness and Action <br /> AFFIDAVIT OF EXEMPTION FOR AUTOMOBILE LIABILITY INSURANCE <br /> Carlos Beltran Arechiga <br /> 1 ("Representative").attest that I am an authorized <br /> Game and Title of Vertdm Relmvsentative) <br /> OCCTAC <br /> representative of !_ (`'Company"),and <br /> (CatsultattUCattpany 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 bet�yeen Company and City of Santa Ana,agreement number _ <br /> Art Classes at the Santa Ana Virtual Academy <br /> ("Agreement')to provide ('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 o«ned/rented/leased/borrowed vehicles to perform 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 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 /> 04/21/2025 <br /> Signahua — Date <br /> Carlos Beltran Arechiga <br /> Not Name <br /> Director of Arts <br /> --_ TWO -- <br /> 714-547-5468 -carlosb®occtac.org <br /> Contact btfunuatiut,i.c.,Tulephune Nmnbcr atd2r fine it.-Wdress <br /> Affidavit of Exemption forAutomobiie Liability Insurance 11.22.2024 ` <br />