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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 AUTOMOBILE LIABILITY INSURANCE <br /> Moises camacho z� <br /> I, { Representative ), attest that I am an authorized <br /> (Naive and Title of Vendor Representative) <br /> representative of oc Fine Art studio ("Company"), and <br /> (Consultant/Company Name) <br /> possess the authority to legally bind Company, <br /> In my capacity as Representative of Company, l represent and confirm the following, as relates to the <br /> agreement between Company and City of Santa Ana, agreement number <br /> ("Agreement")toprovide mural restoration ("Services"): <br /> (Senhces to be provided under agreementicontract) <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/rented/leased/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 /> doeLunent and does not maintain the minimum automobile 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 /> 0 2. '0 3- 2-D 26 <br /> Signature Date <br /> Moises camacho <br /> Print Name <br /> Title <br /> (714) 906-0920 artecamachog4a@gmail.com <br /> Contact Information,i.e.,Telephone Number and/or Email Address <br /> Affidavit of Exemption for Automobile Liability Insurance 11,12,2024 <br />