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Auto Liability (Non-Use Agreement) <br /> Date <br /> City of Santa Ana <br /> Risk Management Division <br /> 20 Civic Center Plaza <br /> Santa Ana, CA 92702 <br /> Re.- Auto insurance Requirement <br /> Dear City of Santa Ana Risk Management Division: <br /> ��C: _Vt�A 10"'� � has intent to enter into an agreement with the City of Santa <br /> Ana.Throughout the course of this agreement, attests to the following: <br /> 1 LLWA-IV _v rl t~:, will not use/drive any vehicle during the course <br /> and scope of the services provided in the agreement/contract. <br /> 2. <<-C will not use any owned/rented,/leased vehicles <br /> during thecourse and scope of the services provided in the agreement/contract. <br /> 3_ 1'+k0,CAAt ,, _ VMQ_S consultants/independent contractors/employees <br /> utilize their personal vehicles/non-company owned, borrowed, or rented/leased <br /> vehicles for transportation to and from work and if applicable carry their own <br /> automobile insurance. <br /> By signing below, 1, S\ 7 CA('e�:> attest that I possess the legal authority <br /> to enter into an agreement with the City of Santa Ana as well as the legal authority <br /> to attest to the statements above. If at any time it is found that <br /> is not adhering to any/all statements in this document and has not provided the <br /> minimum Auto liability insurance coverage of $ 1 million per occurrence, the contract <br /> will be considered nulf and void andthe company will be held fully liable for any and all <br /> damages. <br /> Signature: f <br /> _r <br /> Name: <br /> Job Title: <br /> "i REVIEWED&APPRUV®BY: <br /> Company Name: ` <br /> Contact Phone: 'i`[� 9 Risk Management <br /> ddist <br /> Email Address: '+ { i <br />