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NOTICE OF COMPLIANCE <br />CITY "A',1CC. I1111RINT I'III I III°i II11AG➢E AND INCLUDE CE I 11111 AGR E➢E k1➢EN I TO 1111I E CLERIC CSC 1111I E COUNCIL <br />L <br />Contractor Jorge B Melgoza <br />Name: <br />Project N-2022-027 <br />Number: <br />Project Agreement With Jorge Melgoza, DBA Ardent Ergonomics, To Provide <br />Name: Preventative Ergonomics Assessments <br />The Certificate of Insurance (COI) submitted indicates that the coverages are in compliance with the <br />insurance requirements. No further action is required at this time. <br />The compliant coverage(s) are: <br />EXPIRATION <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />COI DATE <br />FILE NAME <br />DATE <br />BUS CERT CITY <br />AUTOMOBILE LIABILITY <br />5837885D1555 <br />04/15/2024 <br />10/02/2023 <br />OF SANTA ANA <br />2023.pdf <br />GENERAL LIABILITY <br />90E3K8745 <br />10/15/2024 <br />10/02/2023 <br />jorge.pdf <br />Affidavit of <br />Exemption for <br />WORKERS COMPENSATION AND EMPLOYERS' <br />WAIVER <br />01/03/2024 <br />01/05/2023 <br />Workers <br />LIABILITY <br />Compensation <br />Insurance <br />2021.pdf <br />Thank you, <br />City of Santa Ana <br />Risk Management Division <br />in partnership with <br />CTrax Plus Services Team <br />10/25/2023 1:03 PM <br />