Common use of CITY OF OXNARD Attn Clause in Contracts

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._ _ 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 Rev. 5/22 INS-P.DOC 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._ _ 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 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._ _ 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 Rev. 5/22 INS-P.DOC 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