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Lynch, Breanna <br />From: City of Santa Ana <certificate-request@ctraxjdidata.com> <br />Sent: Wednesday, October 25, 2023 10:04 AM <br />To: Lynch, Breanna; Acevedo, Angie; HR Admin <br />Subject: Internal Notice of Compliance <br />NOTICE OF COMPLIANCE <br />CITY STAFF: PRINT THIS PAGE AND INCLUDE WITH AGREEMENT TO THE CLERK OF THE COUNCIL <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 />POLICY <br />EXPIRATION <br />TYPE OF INSURANCE <br />COI DATE <br />FILE NAME <br />NUMBER <br />DATE <br />BUS CERT <br />AUTOMOBILE LIABILITY <br />5837885DI555 <br />04/15/2024 <br />10/02/2021 <br />CITY OF <br />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 <br />Workers <br />EMPLOYERS' LIABILITY <br />WAIVER <br />01/03/2024 <br />01/05/2023 <br />Compensation <br />Insurance <br />2021.pdf <br />Thank you, <br />City of Santa Ana <br />Risk Management Division <br />in partnership with <br />