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CITY OF SANTA ANA <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 Jennifer Backhaus Re resentative attest that [am an authorized <br /> (Name and Title of Vendor Representative) <br /> representative of Backhaus Dance ("Company"), and <br /> (Consultant/Company Nance) <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 p'" ide Dance Classes <br /> provide ("Services"): <br /> {Services to be provided under agreemendcontracty <br /> During the coarse 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 Tu Tran pg,�ys,9^edgy <br /> T,Tran Nguyen <br /> pare:ZOZ5.12.22 <br /> Noa:�2:�svaoa <br /> required in the Agreement, it will be considered a breach of Agreement rendering the Agreement gUyen <br /> null and void and Company will be fully liable for any and all damages. �PPROVED <br /> 7u Tran Nguyen�8:11 �22Z' <br /> P,_a� 12/20/2025 <br /> SiLmature Date <br /> Jennifer Backhaus <br /> Print,Name <br /> Artistic Director <br /> Title <br /> Jenny@backhausdance.org <br /> Contact Information.i.e.,Telephone Number and/or Email Address <br /> Affidavit of Exemption for Automobile Liability insurance 11.12.2021 <br />