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Phone:(714)647-5420 Fax:(714)647.6944 <br />CERTIFICATE OF LIABILITY INSURANCE <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER <br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the poilcy(les) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statementon <br />this certificate does not confer riahts to the certificate hnIder in U.,, of Ruch Andnrae,wnnuaL <br />PRODUCER Triton of Calif Insurance Services, Inc. <br />6000 San Juan Avenue <br />Fair Oaks, CA 95628 <br />License #: OF41767 <br />INSURED <br />TOM BYSTRY <br />DBA: VIDEO ENGINEERING SERVICES <br />14 APPOMATTOX <br />IRVINE, CA 92620 <br />.___ INSUAER(81 AFFORDWp COVERAGE <br />COVERAGES CERTIFICATE NUMBER: 00003962.9368 REVISION NUMBER <br />• <br />30 <br />THIS IS TO CERTIFY T THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />STT <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT. OROTHERDOCUMENT WITH RESPECT TO WHICH THIS <br />TH INSURANCE <br />NCEOR <br />CERTIFICATE ANY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE <br />AFFORDEDTHE POLICIES <br />UCIED DESCRIBED HEREIN is SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BYPAIDCLAIMS. <br />E <br />INBR TYPE OF INSUUINCE L81R! POUCYNUrmER PSI C�V ETP-1 POIIt;Y —.._ .. UNITS ... <br />A <br />X <br />coMNERcw-oeJERALLIAen/rr <br />Y <br />MP0004009006721 <br />o2IDir2020 <br />02lOtr2021 <br />EACH OCCURRENCE <br />i 1000000 <br />Dews MADE OCCUR <br />Edam <br />6 100000 <br />MED E%P aw <br />f 5,000 <br />PERSpML S AVJ INJURY <br />f 1,000,000 <br />UNTAPPLIEB PER: <br />GE4ERMAGQKQATE <br />f 2000000 <br />GENLACAREQAIE <br />PoLICY O PJECR0.T ❑ <br />6 2,000,000 <br />La <br />i <br />PRODVOTs-wNP, AGG <br />It <br />OTHER <br />AUTOMOe1LEL1A91UTY <br />COM& 1 <br />0 <br />6 <br />ANY AUTO <br />BODILY MUURV(Wrperm) <br />6 <br />ONNED SCHEDULED <br />BODILY VARY (PN AtadNq <br />f <br />AUTOB ONLY AUros <br />HIRED NON OV-RJED <br />PRDPERTYDAAWGAGE..._. <br />AUTOS ONLY AUTOBONLY <br />f <br />r <br />f <br />UMBRELLA LUUI <br />BUR <br />F.,ACH OCCURRENCE <br />f <br />EXCESS JAB <br />CWMSAMOE <br />I <br />I <br />AGGREGATE <br />IMI IRETENTION3 <br />6 <br />VA)WfSRBcOMPEWATION <br />pEp <br />IAND EMPLOYERS' LL49NM YIN <br />I <br />E.L EACNADDIDENr <br />i <br />AN1'PROPRIETORRgRiNER1p�Cl/TIVE <br />ovncsR.M I EXCLUDED?1 <br />MIA <br />EL DISEASE -EA EMKOYU <br />6 <br />(1.4nC.tery n Hl <br />i NHi <br />IIyes,dsuNa uMx <br />E.L DI8EABE-FOLICY LwR <br />i <br />DFSgE1PnON OF OPnPAT IONS Mbv <br />OESCRIPnON OF OPEMTM)NSI LOCAnON6I VEMDLE.B IADORD 101, Adtiew,a RmuMe f[MduM. mfY b NbcMO N nlMspsu M MRuhdl <br />The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; Its officers, employees, agents and representatives <br />are named as additional insureds per CG2010 attached to this policy. The Insurance is primary and non-contributory. <br />Certificate of Insurance shall provide thirty (30) day prior written notice of cancellation <br />CERTIFICATE HOLDER 0., D:-I, AA.....-.....,. r1:.a6IAORI I ATIAN <br />City of Santa Ana FE �2020 <br />Risk Management Division <br />EREOF, OTICEWILLANY OF THE ABOVE DESCRIBEDGHES BEDELIVERED IBE N��F <br />THEJIXPIRATIONDTTH <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza, 4 <br />SANTA ANA, CA 92702 ANgiE ACEvEdo <br />p 77E <br />CPR <br />©1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 26 (2016103) The ACORD name and logo am registered marks of ACORD <br />Pnnted by CPR on January 22, 2320 at 11:54AM <br />