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Vega, Brenda <br />From: City of Santa Ana < certificate- request@ctrax.jdidata.com> <br />Sent: Monday, October 9, 2023 8:33 AM <br />To: Vega, Brenda <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 Community Health Initiative of Orange County <br />Name: <br />Project A-2022-092-18 <br />Number: <br />Project Agreement Between The City Of Santa Ana And Community Health <br />Name: Initiative Of Orange County For Use Of Community Development Block <br />Grant Funds <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 />ACORD Fonn <br />AUTOMOBILE LIABILITY <br />202344927 <br />10/15/2024 <br />09/21/2023 <br />20230921- <br />115907.pdf <br />ACORD Form <br />GENERAL LIABILITY <br />202344927 <br />10/15/2024 <br />09/21/2023 <br />20230921- <br />115907.pdf <br />WORKERS COMPENSATION AND <br />ACORD Form <br />928909122 <br />11/05/2024 <br />09/21/2023 <br />20230921- <br />EMPLOYERS' LIABILITY <br />115907.pdf <br />Thank you, <br />City of Santa Ana <br />Risk Management Division <br />in partnership with <br />