Laserfiche WebLink
C. Cesario Medical Consulting LLC <br /> �/i� ('IAffidavit of Exemption for Automobile Liability Insurance <br /> I,lz `basiett.0 x7PPcpttei hereby affirm under penalty of perjury, the <br /> (Name/Title) <br /> following declaration: fI ' <br /> I certify on behalf of e c ��lo cowPtK(s 4[uat during the term <br /> (Con ultant/ o pany Name) JJ / <br /> of my contract for 3 at) services with the City of Santa Ana, <br /> (Type of service provided) <br /> I will not use/drive any vehicle during the course and scope of the services provided <br /> in the agreement/contract. I will not use any owned/rented/leased vehicles during <br /> the course and scope of the services provided in the agreement/contract. Our <br /> consultants/independent contractors/employees utilize their personal vehicles/non- <br /> company owned, borrowed, or rented/leased vehicles for transportation to and from <br /> work and if applicable carry their own automobile insurance. <br /> By signing below, I attest that I possess the legal authority to enter into an agreement <br /> with the City of Santa Ana as well as t e legal au iority to est to the 1s atements <br /> above. If at any time it is found that Qileca6lO� d)hjL& kitis not <br /> (Consultant/Company Name)✓ <br /> adhering to any/all statements in this document and has not provided the minimum <br /> Auto liability insurance coverage of $1 million per occurrence, the contract will be <br /> considered null and void and the company will be held fully liable for any and all <br /> damages. `� <br /> Date: SW�9j � � a ., n <br /> Print Name: \.45.1�\ U/ f�AAk) <br /> Print Title: "e <br /> Signature: �r ) OI <br /> Telephone: , v6 5Sq n 7I <br /> s, R1ekMcnmgementD[Wsbn _ <br /> P.O. Box 510693 I Key Colony Beach, FL 133051 I (305) 389 8 RENEWEo&MPROV®BY: <br /> Actudo <br /> ccesariomc@gmail.com <br /> ' Risk Manayemen[Spedalist <br />