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 Exhibit INS-X AUTOMOBILE LIABILITY SPECIAL ENDORSEMENT SUBMIT IN DUPLICATE 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 AUTOMOBILE LIABILITY SPECIAL ENDORSEMENT FOR THE CITY OF OXNARD (the “City”) PRODUCER POLICY INFORMATION: Insurance Company: Policy No.: SUBMIT IN DUPLICATE ENDORSEMENT NO. ISSUE DATE (MM/DD/YY) Telephone: NAMED INSURED 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) 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 CITY AGREEMENTS/PERMITS TYPE OF INSURANCE OTHER PROVISIONS COMMERCIAL AUTO POLICY BUSINESS AUTO POLICY OTHER LIMIT OF LIABILITY $ per accident, for bodily injury and property damage. CLAIMS: Underwriter’s representative for claims pursuant to this insurance. Name: Address:
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 Bond No. PAYMENT BOND (LABOR AND MATERIALS) KNOW ALL PERSONS BY THESE PRESENTS that: WHEREAS the City of Oxnard (“Agency”), State of California, has awarded to (“Principal”) (Name and address of Contractor) 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. 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 Bond No. PAYMENT BOND (LABOR AND MATERIALS) KNOW ALL PERSONS BY THESE PRESENTS that: WHEREAS the City of Oxnard (“Agency”), State of California, has awarded to (“Principal”) (Name and address of Contractor) 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. 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. 5/22 INS-P.doc City of Oxnard City Council Approved Cannabis Community Benefit Agreement October 20, 2020 The City of Oxnard is reserving two (2) of the ten (10) retail cannabis permits to Local Equity Retail Cannabis applicants. Applicants who meet the definition as defined below shall be considered a Local Equity Retail Cannabis applicant. All applicants are required to sign a Community Benefits Agreement as a condition of approval.
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 Bond No. PAYMENT BOND (LABOR AND MATERIALS) KNOW ALL PERSONS BY THESE PRESENTS that: WHEREAS the City of Oxnard (“Agency”), State of California, has awarded to (“Principal”) (Name and address of Contractor) 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. 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 AUTOMOBILE LIABILITY SPECIAL ENDORSEMENT SUBMIT IN DUPLICATE 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 TYPE OF INSURANCE OTHER PROVISIONS COMMERCIAL AUTO POLICY BUSINESS AUTO POLICY OTHER LIMIT OF LIABILITY CLAIMS: Underwriter’s representative for claims pursuant to this insurance. Name: $ per accident, for bodily injury and property damage. Address: Telephone: ( )
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
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: Rev. 11/13INS-A.doc SUBMIT IN DUPLICATE AUTOMOBILE LIABILITY SPECIAL ENDORSEMENT FOR THE CITY OF OXNARD (the “City”) ENDORSEME NT NO. ISSUE DATE (MM/DD/YY) PRODUCER POLICY INFORMATION: Telephone: 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
