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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 /> l Richard Serrato _ _("Representative"),attest that l am an authorized <br /> (Name and Title of Vendor ttepreseniative)— <br /> Santa Ana Lawn Bowling Club <br /> and <br /> representati g ve of ("Company"), <br /> Woustdlant)Couipany Name) <br /> possess the authority to legally bind Company, <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 /> ("Agreement")to provide Coaching lawn bowling at Santa Ana Lawn Bowling center ("Services"): <br /> (Services to be provided under aguornent/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/rented/leased/borrowed vehicles to perform Services to, for,or on <br /> behalf of City of Santa Ana. <br /> lfat any time it is found that Company is not adhering to any and/or all of the statements in this <br /> document and floes 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 /> _ 12/15/2025 <br /> Signature pate <br /> Richard Serrato <br /> Print Name <br /> Bowls USA Certified Coach <br /> 714 322-0945, richardserrato@yahoo.com <br /> — Contact Information,i.e.,"telephone Number and/or Email Address <br /> Affidavit of Exemption for Automobile Liahllity Insurance 11,12,2024 <br /> i <br />