CITY OF OXNARD Attn Sample Clauses

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. 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. 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 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 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. 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. 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

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