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Burrola, Melissa <br />From: City of Santa Ana <certificate-request@ctrax.jdidata.com> <br />Sent: Wednesday, November 23, 2022 12:18 PM <br />To: NBiro Blue MT Development; Burrola, Melissa; Thomas, Sean; veronica@bulen.com <br />Subject: Internal Notice of Compliance <br />NOTICE OF COMPLIANCE <br />CITY STAFF: PRINT THIS PAGE .AND INCLUDE WITH AGREEMENT TO THE CLERK OFT" E COUNCIL <br />Contractor Blue Mountain Development, Inc. <br />Name: <br />Project TBD (101) <br />Number: <br />Project AGREEMENT BETWEEN THE CITY OF SANTA ANA AND BLUE <br />Name: MOUNTAIN DEVELOPMENT FOR ART INSTALLATION PROGRAM <br />MANAGEMENT SERVICES <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 />TYPE OF INSURANCE <br />AUTOMOBILE LIABILITY <br />GENERAL LIABILITY <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY <br />Thank you, <br />City of Santa Ana <br />Risk Management Division <br />POLICY EXPIRATION <br />NUMBER DATE <br />4031144935 <br />4031144935 <br />WAIVER <br />11/04/2023 <br />I1/04/2023 <br />10/10/2023 <br />COI DATE FILE NAME <br />11/18/2022 Risk <br />Management.pd£ <br />11/18/2022 Risk <br />Management.pdf <br />Affidavit of <br />Exemption for <br />11/18/2022 Workers <br />Compensation <br />Insurance <br />2022.pdf <br />1 <br />