CITY OF OXNARD Attn. Insurance Compliance Reference No._ _ X.X. Xxx 000000 – OX Xxxxxx, XX 00000 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 AUTHORIZED REPRESENTATIVE ❒ Broker/Agent ❒ Underwriter ❒ I (print/type name), warrant that I have authority to bind the above-mentioned insurance company and by my signature hereon do so bind this company to this endorsement. Signature (original signature required) Telephone: ( ) Date Signed
CITY OF OXNARD Attn. Insurance Compliance Reference No._ _ X.X. Xxx 000000 – OX Xxxxxx, XX 00000 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 AUTHORIZED REPRESENTATIVE ❒ Broker/Agent ❒ Underwriter ❒ I (print/type name), warrant that I have authority to bind the above-mentioned insurance company and by my signature hereon do so bind this company to this endorsement. Signature (original signature required) Telephone: ( ) Date Signed FOR THE CITY OF OXNARD (the ACity@) ENDORSEMENT NO. ISSUE DATE (MM/DD/YY) PRODUCER POLICY INFORMATION: Insurance Company: Policy No.: Policy Period: (from) (to) LOSS ADJUSTMENT EXPENSE □ Included in Limits □ In Addition to Limits Telephone: ❒ Deductible ❒ Self-Insured Retention (check which) of $ with an Aggregate of $ applies to coverage. ❒ Per Occurrence ❒ Per Claim (which) NAMED INSURED
CITY OF OXNARD Attn. Insurance Compliance Reference No. P.O. Box 100085 – OX Xxxxxx, XX 00000 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 AUTHORIZED REPRESENTATIVE Broker/Agent Underwriter I (print/type name), warrant that I have authority to bind the above-mentioned insurance company and by my signature hereon do so bind this company to this endorsement. Signature (original signature required) Telephone: ( ) Date Signed Rev. 2/20 INS-X.doc FOR THE CITY OF OXNARD (the “City”) PRODUCER POLICY INFORMATION: Insurance Company: Policy No.: Telephone: NAMED INSURED Policy Period: (from) (to) LOSS ADJUSTMENT EXPENSE Included in Limits Deductible Self-Insured Retention (check which) of $ with an Aggregate of $ applies to coverage. Per Occurrence Per Claim (which) APPLICABILITY: This insurance pertains to the operations, products and/or tenancy of the named insured under all written agreements and permits in force with the City unless checked TYPE OF INSURANCE COMMERCIAL AUTO POLICY BUSINESS AUTO POLICY OTHER LIMIT OF LIABILITY $ per accident, for bodily injury and property damage. Underwriter’s representative for claims pursuant to this insurance. Name: Address:
CITY OF OXNARD Attn. Insurance Compliance Reference No._ A-8298 P.O. Box 100085 – OX Xxxxxx, XX 00000 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 AUTHORIZED REPRESENTATIVE Broker/Agent Underwriter I (print/type name), warrant that I have authority to bind the above-mentioned insurance company and by my signature hereon do so bind this company to this endorsement. Signature (original signature required) Telephone: ( ) Date Signed Rev. 1/21 INS-S.doc KNOW ALL PERSONS BY THESE PRESENTS that: WHEREAS the City of Oxnard (“Agency”), State of California, has awarded to a contract (the “Contract”) for the Work described as On-Call Channel Maintenance and Repair Services Project for Waterways Assessment Districts Specification No. SD 21-43 (the “Project”).
CITY OF OXNARD Attn. Risk Manager Reference Xx. 000 X. Xxxxx Xxxxxx, Xxxxx 000 Xxxxxx, XX 00000 AUTHORIZED REPRESENTATIVE Broker/Agent Underwriter I (print/type name), warrant that I have authority to bind the above-mentioned insurance company and by my signature hereon do so bind this company to this endorsement. Signature (original signature required) Telephone: ( ) Date Signed Exhibit B Rev. 5/17 INS-M.doc FOR THE CITY OF OXNARD (the “City”) ENDORSEMENT NO. ISSUE DATE (MM/DD/YY) PRODUCER Telephone: POLICY INFORMATION: Insurance Company: Policy No.: Policy Period: (from) LOSS ADJUSTMENT EXPENSE (to) Included in Limits In Addition to Limits Deductible Self-Insured Retention (check which) of $ with an Aggregate of $ applies to coverage. Per Occurrence Per Claim (which) NAMED INSURED APPLICABILITY. This insurance pertains to the operations, products and/or tenancy of the named insured under all written agreements and permits in force with the City unless checked here in which case only the following specific agreements and permits with the City are covered: CITY AGREEMENTS/PERMITS COMMERCIAL AUTO POLICY BUSINESS AUTO POLICY OTHER insurance. Name: $ per accident, for bodily injury and property damage. Address: Telephone: ( )
CITY OF OXNARD Attn. Insurance Compliance Reference No. P.O. Box 100085 – OX Xxxxxx, XX 00000 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 AUTHORIZED REPRESENTATIVE Broker/Agent Underwriter I (print/type name), warrant that I have authority to bind the above-mentioned insurance company and by my signature hereon do so bind this company to this endorsement. Signature (original signature required) Telephone: ( ) Date Signed KNOW ALL PERSONS BY THESE PRESENTS that: WHEREAS the City of Oxnard (“Agency”), State of California, has awarded to a contract (the “Contract”) for the Work described as CENTRAL TRUNK SEWER MANHOLE REPLACEMENT PROJECT PHASE I SPECIFICATION NO. PW 21-28.
CITY OF OXNARD Attn. Insurance Compliance Reference No. P.O. Box 100085 – OX Duluth, GA 30096 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 AUTHORIZED REPRESENTATIVE □ Broker/Agent □ Underwriter □ I (print/type name), warrant that I have authority to bind the above-mentioned insurance company and by my signature hereon do so bind this company to this endorsement. Signature (original signature required) Telephone: ( ) Date Signed Rev. 1/20 INS-C.doc Rev. 1/20 INS-C.doc AUTOMOBILE LIABILITY SPECIAL ENDORSEMENT FOR THE CITY OF OXNARD (the “City”) ENDORSEMENT NO. ISSUE DATE (MM/DD/YY) PRODUCER Telephone: POLICY INFORMATION: Insurance Company: Policy No.: Policy Period: (from) (to) LOSS ADJUSTMENT EXPENSE □ Included in Limits □ In Addition to Limits □ Deductible □ Self-Insured Retention (check which) of $ with an Aggregate of $ applies to coverage. □ Per Occurrence □ Per Claim (which) NAMED INSURED
CITY OF OXNARD Attn. Insurance Compliance Reference No._ A-8298 P.O. Box 100085 – OX Xxxxxx, XX 00000 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 AUTHORIZED REPRESENTATIVE Broker/Agent Underwriter I (print/type name), warrant that I have authority to bind the above-mentioned insurance company and by my signature hereon do so bind this company to this endorsement. Signature (original signature required) Telephone: ( ) Date Signed Rev. 1/21 INS-S.doc FOR THE CITY OF OXNARD (the “City”) ENDORSEMENT NO. ISSUE DATE (MM/DD/YY) PRODUCER POLICY INFORMATION: Insurance Company: Policy No.: Policy Period: (from) (to) LOSS ADJUSTMENT EXPENSE Included in Limits In Addition to Limits Telephone: Deductible Self-Insured Retention (check which) of $ NAMED INSURED with an Aggregate of $ applies to coverage. Per Occurrence Per Claim (which) APPLICABILITY. This insurance pertains to the operations, products and/or tenancy of the named insured under all written agreements and permits in force with the City unless checked here in which case only the following specific agreements and permits with the City are covered: CITY AGREEMENTS/PERMITS COMMERCIAL AUTO POLICY BUSINESS AUTO POLICY OTHER LIMIT OF LIABILITY CLAIMS: Underwriter’s representative for claims pursuant to this insurance. $ per accident, for bodily injury and property damage. Name: Address: Telephone: ( )
CITY OF OXNARD Attn. Insurance Compliance Reference No. P.O. Box 100085 – OX Duluth, GA 30096 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 AUTHORIZED REPRESENTATIVE □ Broker/Agent □ Underwriter □ I (print/type name), warrant that I have authority to bind the above-mentioned insurance company and by my signature hereon do so bind this company to this endorsement. Signature (original signature required) Telephone: ( ) Date Signed PAYMENT BOND (LABOR AND MATERIALS) KNOW ALL PERSONS BY THESE PRESENTS that: WHEREAS the City of Oxnard (“Agency”), State of California, has awarded to a contract (the “Contract”) for the Work described as the On-Call Tree Maintenance Services Project Specification No. PW 20-22 (the “Project”).
CITY OF OXNARD Attn. Risk Manager Reference Xx. Xxxxxxxxx Xx. 0000-00-XX 000 X. Xxxxx Xxxxxx, Xxxxx 000 Xxxxxx, XX 00000 AUTHORIZED REPRESENTATIVE ❒ Broker/Agent ❒ Underwriter ❒ I (print/type name), warrant that I have authority to bind the above-mentioned insurance company and by my signature hereon do so bind this company to this endorsement. Signature (original signature required) Telephone: ( ) Date Signed
