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A-2018-210-02 NOTICE OF COMPLIANCE CITY STAFF: PRINT THIS PAGE AND INCLUDE WITB AGREEMENT TO TRF CLERK OF THE COUNCIL Contractor AdminSure, Inc. Name: Project A-2018-210-01 Number: Project Professional Services Agreement for Third Party Workers' Compensation Name: Claims Administration The Certificate of Insurance (C01) submitted indicates that the coverages are in compliance with the insurance requirements. No further action is required at this time. The compliant coverage(s) are: TYPE OF INSURANCE POLICY EXPIRATION COI DATE FILE NAME ------------------------- NUMBER ._---- --- ___w.__..._., DATE AUTOMOBILE LIABILITY 7036373744 ___------------------- ______ 01/01/2024 __._----- _-..___________......... 01/04/2023 ............ _.__..._____-____...._ ADMSU- _._____........ ....... _......... _______. __.___.__ ._ _ _ ___._.............__........_____. ---_....._.._....____..__._....._...... 199994.pdf .............._...______._-_......_ CRIME 6260392656 01/01/2024 01/09/2023 ADMSU- _ .... _________.. __. __..______ .._.__. 199994.pdf CYBER LIABILITY H23NGP221562 01/01/2024 01/04/2023 ADMSU- .. _ _._ ____________..__. 199994 pdf -__.._.... CYBER LIABILITY H23NGP221562 01/01/2024 01/04/2023 ADMSU- _ ______- .-. ......... 199994.pdf GENERAL LIABILITY 7036373730 01/01/2024 01/10/2023 ADMSU- 199994.pdf WORKERS ON AND 7036374814 01/01/2024 Y ^ 01/04/2023 ADMSU- Yl^ EMPLO ERSOLIABILITY I ^Y ^1999 94.pdf Thank you, City of Santa Ana Risk Management Division in partnership with CTrax Plus Services Team 1/11/20231:01 PM