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CITY OF SANTA ANAAEN <br /> Risk Management a division of Human Resources <br /> Managing Risk through Awareness and Action <br /> AFFIDAVIT OF EXEMPTION FOR AUTOMOBILE LIABILITY INSURANCE <br /> I, r , d ("Representative"),attest that I am an authorized <br /> ame and Title of vendor Representative) <br /> representative of (7 ("Company"), and <br /> (C nsul t/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 l <br /> ("Agreement")to provide_ 1 NeS Ir ti r i5� hya+- . "Services"): <br /> (SepUces to be provided tender agreementicontract) <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 andlor 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 /> l <br /> Signature 1 Date <br /> r <br /> Print N <br /> 1 � <br /> Title <br /> Contact Information,i.e.,"telephone Number and/or Email Address <br /> Affidavit of Exemption for Automobile Liability Insurance 11.12.2024 <br />