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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 /> E, C'�Llt� � u'fC1Ct "4 i/ ("Representative"),attest that I am an authorized <br /> (Name and Title of Vendor Representative) <br /> representative of ,-TA(?V),Q k CA ("Company"),and <br /> (Consul[ant/Compan•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 !4-t�n--�-t +rl u� C.t e UtJ tG_5 !`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 al[ 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 /> / /) <br /> is ature `� Date <br /> ct_\C-41c, It cat &-luso .4 C t <br /> Print Name T: <br /> tU C� c rS <br /> Title <br /> Contact tnformiation,i-e,Telephone Number and/or Email Address <br /> Affidavit of Exemption for Automobile Liability Insurance 11.12.2024 <br />