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Le, Tram <br />From: City of Santa Ana <certificate-request@ctraxjdidata.com> <br />Sent: Thursday, December 14, 2023 5:24 PM <br />To: Le, Tram; jenny@backhausedance.org <br />Subject: Internal Notice of Compliance <br />NOTICE OF COMPLIANCE <br />CIT% STAFF: PRINT THIS PAGE AND INCLUDE WITH AGREENI ENT TO'I"HE CLERK OFT" ECOLNCIL <br />Contractor Backhaus Dance <br />Name: <br />Project N-2021-250-02 <br />Number: <br />Project Second Amendment To Agreement With Jennifer Backhaus DBA <br />Name: Backhaus Dance For Provision Of Ballet And Creative Movement Classes <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 />ABUSE & MOLESTATION <br />GLP3961460 <br />06/03/2024 <br />05/03/2023 <br />Backhaus- Santa <br />Ana.pdf <br />Auto Liability <br />(Non -Use <br />AUTOMOBILE LIABILITY <br />WAIVER <br />05/31/2024 <br />06/02/2023 <br />Agreement) <br />Request for <br />Waiver Fillable <br />(2).pdf <br />GENERAL LIABILITY <br />GLP3961460 <br />06/03/2024 <br />05/03/2023 <br />Backhaus- Santa <br />Ana.pdf <br />Workers <br />WORKERS COMPENSATION AND <br />WC8094602 <br />09/07/2024 <br />09/06/2023 <br />Compensation - <br />EMPLOYERS' LIABILITY <br />Backhaus <br />Dance.pdf <br />Thank you, <br />1 <br />