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NASH REFEREE, INC. (2)
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NASH REFEREE, INC. (2)
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Last modified
5/14/2025 9:20:32 AM
Creation date
5/14/2025 9:20:11 AM
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Contracts
Company Name
NASH REFEREE, INC.
Contract #
N-2025-116
Agency
Parks, Recreation, & Community Services
Expiration Date
5/31/2027
Insurance Exp Date
8/1/2025
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CITY OF SANTA ANA <br /> Risk Management a division of Human Resources <br /> Managing Risk through Awareness and Action 4 " <br /> AFFIDAVIT OF EXEMPTION FOR AUTOMOBILE LIABILITY INSURANCE <br /> I, inlot111 ("Representative"),attest that I am an authorized <br /> (Name and Title of Vendor Representative) <br /> representative of fts4tiftbrw Inc. ("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 <br /> ("Agreement")to provide rw*1989 i ("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 /> 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 /> 4 c <br /> 41M=5 <br /> Signature Date <br /> � 11 <br /> Print Name <br /> amm <br /> I ide <br /> Contact Information,i.e.,Telephone Number and/or Email Address <br /> Affidavit of Exemption for Automobile Liability Insurance 11.12.2024 <br />
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