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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 PROFESSIONAL LIABILITY INSURANCE <br />I, /'' ✓ ("Representative"), attest that I am an authorized <br />(Name and Titl of Vendor Represent ve) <br />representative of (26T ("Company"), and <br />(Consultant/Company bfamO <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 A-2023-069-17 <br />("Agreement") to provide <br />Workforce Training <br />(Services to be provided under agreementicontract) <br />("Services"): <br />During the course and scope of Company's agreement with the City of Santa Ana, <br />Company will not use the services of an expert necessitating professional liability/errors <br />& omissions liability insurance coverage 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 minimum professional 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 />� tz� <br />Signature -�ZDate <br />r/ <br />Print Name <br />Title <br />Contact Information, i.e., <br />4. " T. Z- C � <br />and/or Email <br />Affidavit of Exemption for Professional Liability Insurance <br />11.12.2024 <br />