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From: City of Santa Ana <br />To: infola)bavcocom: Fernandez. Armando heidiffa)siobrokers comReyes. Kathia: 7avala. Talisa <br />Subject: Internal Notice of Compliance <br />Date: Wednesday, November 23, 2022 9:01:03 AM <br />NOTICE OF COMPLIANCE <br />CITY STAFF: PRINT THIS PAGE AND INCLUDE NN1TH AGREEMENT TO THE CLERK OF THE COUNCIL <br />Contractor Backflow Apparatus & Valve <br />Name: <br />Project N-2020-153 <br />Number: <br />Project N-2020-153 <br />Name: <br />The Certificate of Insurance (COI) submitted indicates that the coverages are in <br />compliance with the insurance requirements. No further action is required at this <br />time. <br />The compliant coverage(s) are: <br />TYPE OF INSURANCE POLICY XPIRATION NUMBER DATE COI DATE FILE NAME <br />AUTOMOBILE LLABILITY <br />GENERAL LIABILITY <br />PROFESSIONAL LIABILITY <br />WORKERS <br />BA7N173419 10/31/2023 10/18/2022 <br />630SJ664090 10/31/2023 10/18/2022 <br />WAIVER 11/21/2023 11/22/2022 <br />COMPENSATION AND UB3R1557402214G <br />EMPLOYERS' LIABILITY <br />Thank you, <br />City of Santa Ana <br />Risk Management Division <br />m parbrershlp % ith <br />CTrax Plus Services Team <br />11/23/2022 12:00 PM <br />08/27/2023 ! 10/18/2022 <br />i <br />CERT- <br />1219044408.pdf <br />CERT- <br />1219044408.pdf <br />Santa Ana.pdf <br />CERT- <br />1219044408.pdf <br />