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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 />James Staab - President <br />(Name and Title of Vendor Representative) <br />representative of Select Electric, Inc. <br />(Consultant/Company <br />possess the authority to legally bind Company. <br />("Representative"), attest that I am an authorized <br />("Company"), and <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 />25-6030 <br />("Agreement") to provide Traffic Signal Installation ("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 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 />myNsov apnea er.wmei swat <br />James Staab Eos02 a2514zfi ®ed <br />Signature <br />James Staab <br />President <br />1-. 2/25/2025 <br />`ssiwl"snN <br />Tu Tran „;T, Tr <br />James.Staab@selectelectricinc.com Nguyen°ou,a,,, <br />Contact Information, i.e., Telephone Number and/or Email Address isue:roaeoo <br />APPROVED <br />Affidavit of Exemption for Professional Liability Insurance By Tu Train Nguyen at 4:08 pm, Feb 25, 2025 <br />