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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 AUTOMOBILF LIABILITY INSURANCE <br />� Elson De Cantuaria <br />('�Amc and Title��t �'cnt1or Rc�+tr�cnt;►tnct <br />Matchpoint Tennis Academy' LLC <br />r���n�:�etlt�iti��c of <br />(Consultant Campan\ Name) <br />possess the authority to legally bind Company. <br />that I am an atithorized <br />614.any") , and <br />In my capacity as Reprcsentative of Company, I represent and confine the following, as relates to the <br />ai!re meet between Cony pany and Cityf Santa Ana, cigreement nnt�� r <br />"At!reemeet'') to provicue <br />A-2019-241 <br />Management, operation, and maintenance of the C-it)rdlo Tennis Center Services"): <br />(Services to be pro%. tdcd 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/rentedlleased/ 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 111Surance coverage as <br />required in the Agreement, it will be considered a breach of Agreement renderincy the Agreement <br />null and �'40•o� and <br />Company grill be fully liable for any and all damages. <br />Signature <br />Elson De Cantuaria <br />Print Name <br />Owner/Manager <br />J ItIc <br />714-724-9407 / d eca ntu2006 @yahoo. com <br />-�-- Contact Inf'urr anon, i.e,, Telephone Number and./or Emad Address <br />000 <br />"3 /C2-C;L/ C <br />Date <br />Affidavit of Exemption for Automobile Liability Insurance 11.12-2024 <br />