Common use of CITY OF OXNARD Attn Clause in Contracts

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. ._ 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 AUTOMOBILE LIABILITY SPECIAL ENDORSEMENT SUBMIT IN DUPLICATE FOR THE CITY OF OXNARD (the “City”) ENDORSEMENT NO. ISSUE DATE (MM/DD/YY) 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 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 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. $ per accident, for bodily injury and property damage. Name: 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 Rev. 2/20 INS-X.doc 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. ._ 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 AUTOMOBILE LIABILITY SPECIAL ENDORSEMENT SUBMIT IN DUPLICATE FOR THE CITY OF OXNARD (the “City”) ENDORSEMENT NO. ISSUE DATE (MM/DD/YY) 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  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 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. $ per accident, for bodily injury and property damage. Name: Address:: Telephone: ( )