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Perez, Dora <br />From: City of Santa Ana <certificate-request@ctrax.jdidata.com> <br />Sent: Friday, November 3, 2023 1:44 PM <br />To: Perez, Dora <br />Subject: Internal Notice of Compliance <br />NOTICE OF COMPLIANCE <br />CITISTAFF: PRINT THIS PAGE AND INCLUDE WITH AGREEMENT TO THE CLERK OF THE COUNCIL <br />Contractor Blue Mountain Development, Inc. <br />Name: <br />Project N-2022-360 <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 />POLICY <br />EXPIRATION <br />COI DATE <br />FILE NAME <br />NUMBER <br />DATE <br />AUTOMOBILE LIABILITY <br />7036414437 <br />11/04/2024 <br />10/19/2023 <br />City of Santa <br />Ana.pdf <br />GENERAL LIABILITY <br />4031144935 <br />11/04/2024 <br />10/19/2023 <br />City of Santa <br />Ana.pdf <br />Affidavit of <br />Exemption for <br />WORKERS COMPENSATION EXEMPTION <br />WAIVER <br />10/10/2024 <br />10/11/2023 <br />Workers <br />Compensation <br />Insurance <br />2023.pdf <br />Thank you, <br />City of Santa Ana <br />Risk Management Division <br />1 <br />