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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, Richard Kuk Re resentative"(" p ), attest that I am an authorized <br /> (Name and Title of Vendor[Representative) <br /> representative of Inter-Pacific, Inc. ("Company"),and <br /> (Consultant/Company Name) <br /> possess the authority to legally bind Company. <br /> In my capacity as Representative of Company, 1 represent and confirm the following, as relates to the <br /> agreement between Company and City of Santa Ana,agreement number A-2022-025-01 <br /> ("Agreement")to provide Electrical Maintenance ("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 /> 1451_:�� March 20, 2025 <br /> sign Date <br /> Richard Y. Kuk <br /> Print Name <br /> President <br /> Title <br /> rkuk@inter-pacific.com <br /> Contact Information,i.e.,Telephone Number and/or Email Address <br /> Affidavit of Exemption for Professional liability insurance 11.12.2024 <br />