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
Appears in 7 contracts
Samples: Community Benefits Agreement, Community Benefits Agreement, Community Benefits Agreement
CITY OF OXNARD Attn. Insurance Compliance Reference No._ _ X.X. Xxx 000000 P.O. Box 100085 – OX XxxxxxDuluth, XX 00000 GA 30096 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 AUTHORIZED REPRESENTATIVE 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
Appears in 2 contracts
Samples: On Call Professional Services Agreement, Trade Services Agreement
CITY OF OXNARD Attn. Insurance Compliance Reference No._ _ X.X. Xxx 000000 P.O. Box 100085 – OX XxxxxxDuluth, XX 00000 GA 30096 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 AUTHORIZED REPRESENTATIVE ❒ 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
Appears in 2 contracts
Samples: Professional Services, Professional Services
CITY OF OXNARD Attn. Insurance Compliance Reference No._ _ X.X. Xxx 000000 . P.O. Box 100085 – OX XxxxxxDuluth, XX 00000 GA 30096 Via Email: xxxxxxxxxxxx@xxxx.xxx Via Fax: 000-000-0000 AUTHORIZED REPRESENTATIVE ❒ 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
Appears in 1 contract
Samples: Professional Services
CITY OF OXNARD Attn. Insurance Compliance Reference No._ _ X.X. Xxx 000000 P.O. Box 100085 – OX XxxxxxDuluth, XX 00000 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
Appears in 1 contract
Samples: Community Benefits Agreement
