Declaration Regarding Automobile Insurance Requirements Legal or DBA Name of Business:
(“Insured”).
DECLARATION
I hereby declare I am the authorized representative of the aforementioned Contractor. At this time, the requirement to carry automobile liability insurance as described under Sections 3.311 (B) and 3.3.11.2 (B) of the Implementation and Management of a CAD/AVL/APC Integrated System Agreement with the City is not applicable, for the following reasons:
(Initial) I hereby certify on behalf of Contractor that Contractor does not personally possess, own, borrow, rent, or use any vehicle on or behalf of, or directly for, the Contractor for use in the course of performance of the obligations under the Implementation and Management of a CAD/AVL/APC Integrated System Agreement.
(Initial) I hereby certify on behalf of Contractor that Contractor does not have any employees, contractors, or subcontractors that possess, own, borrow, rent, or use any vehicles on behalf of, or directly for, the Contractor for use in the course of performance of the obligations under the Implementation and Management of a CAD/AVL/APC Integrated System Agreement. (Initial) If hereby certify on behalf of Contractor that if Contractor, or any employee, contractor, or subcontractor of Contractor, possesses or uses a vehicle or automobile during the term of this Grant Agreement and in the course of performance of the obligations under the Implementation and Management of a CAD/AVL/APC Integrated System Agreement, I will immediately notify the City and provide proof of automobile insurance as required under the Agreement
(Initial) Contractor agrees to hold the City harmless for loss or liability which may arise from failure to comply with the insurance requirements pursuant to the Agreement and this Declaration.
CERTIFICATION
I certify under penalty of perjury on behalf of Contractor that I have read and understand the above-stated requirements regarding automobile liability insurance and that Contractor is in compliance I certify on behalf of Contractor that the foregoing is true and correct.
Date Signature of Insured
Print Name of Insured
Transit Fixed / On - Demand, LLC
12/02/2025
James Hajek, CFO and Secretary
Attachment 2
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