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<br /> <br /> <br />NOTICE OF COMPLIANCE <br /> <br />CITY STAFF: PRINT THIS PAGE AND INCLUDE WITH AGREEMENT TO THE CLERK OF THE COUNCIL <br />Contractor <br /> Jorge B Melgoza <br />Name: <br />Project <br /> N-2022-027 <br />Number: <br />Project Agreement With Jorge Melgoza, DBA Ardent Ergonomics, To <br /> <br />Name: Provide Preventative Ergonomics Assessments <br /> <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 time. <br /> <br />The compliant coverage(s) are: <br />POLICY EXPIRATION <br />TYPE OF INSURANCE COI DATE FILE NAME <br />NUMBER DATE <br />AUTOMOBILE LIABILITY 5837885D1555 04/15/2023 09/30/2022 Melgoza.pdf <br />BUS CERT <br />GENERAL LIABILITY 90E3K8745 10/15/2023 10/10/2022 2022 <br />MELGOZA.pdf <br />Affidavit of <br />Exemption for <br />WORKERS COMPENSATION AND Workers <br />WAIVER 01/03/2024 01/05/2023 <br />EMPLOYERS' LIABILITY Compensation <br />Insurance <br />2021.pdf <br /> <br />Thank you, <br /> <br />City of Santa Ana <br />Risk Management Division <br />in partnership with <br />CTrax Plus Services Team <br />1/9/2023 5:17 PM <br /> <br />