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CITY OF SANTA ANA <br /> Risk Management a division of Human Resources t <br /> Managing Risk through Awareness and Action <br /> AFFIDAVIT OF EXEMPTION FOR PROFESSIONAL LIABILITY INSURANCE <br /> r r <br /> I,o i ( , (..Representative"),attest that I am an authorized <br /> iNamc and Title of Venl r 'spas.+cn¢.it a{tl <br /> representative of U — t T 1n0 -,--(--Company-),and <br /> Consultan t'ompunp Name) <br /> possess the authority to legally bind Company. <br /> [it 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 munber <br /> ��"r LLP cz <br /> ("Agreement°')to provide orl-('Of(-Tic, h t( WJ1. _ )f mi - 1"Services-): <br /> t Services to br rrnti ided under agreemem contras) <br /> During the course and scope of Company's agreement''.vith the City of Santa Ana, <br /> Company will not use the services of an expert necessitating professional liability/errors <br /> &omissions liability insurance covera,e 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 minitnurtt professional liability insurance coveragge as <br /> required in the Agreement, it will be considered a breach of Agreement rendering:the Agreetent <br /> null and void and Company will be fully liable for any and all damages. <br /> I i <br /> v/'a <br /> �gnalur4 "Stv` <br /> ..Ia LL <br /> / r� <br /> Pnnt Name <br /> J <br /> 1 ale <br /> Contact Information.i.e..TApiltifie Nun+e an&0 Ftnait Akldnts5 <br /> Affidavit of Exemption for Professional Liability Insurance 11 12,2024 <br />