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Risk Management a division of Human Resources RWCVk IL <br /> Managing Risk through Awareness and Action VW <br /> AFFIDAVIT OF EXEMPTION FOR AUTOMOBILE LIABILITY INSURANCE <br /> ("Representative"),attest that I am an authorized <br /> (Name and Title of Vendor Representative) <br /> representative of ("Company"),and <br /> (Consultan(/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 <br /> ("Agreement")to provide -G al� �--(5,A%JQF O( 1 Q <br /> a-r-�<Vk`` raa- ("Services")- <br /> (Services to be provided under agrcementicontract) <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 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 /> 6j2 '--2 1f 2-XS <br /> Signature ate <br /> Print Name <br /> Title <br /> 404 616 ( 0 <br /> Contact Informaiio ,i.e.,Telephone Number and/or Email ddress <br /> Afria%rit of Fvn.enri—r:.,..n,......,..s.a..,:—,:...:--•----- 1,. t a IMA <br />