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CERTIFICATE OF LIABILITY INSURANCE D012712 4Yl <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 policy(les) must he endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder In lieu of such endorsements . <br />PRODUCER X° Chris Rudolph _ <br />Triton of Calif Insurance Services, Inc. PHONE <br />2332 Auburn Blvd PROkIL° ' OL48547Da arc Nnl;, t91e)aaB-919a <br />Sacramento CA 95821 .tip2t+sa chdB(trnanmsamnce cam <br />License 9 OF41767 . _.__ - IMBURaR[BtAPFOR01Nq COYERAOE._._ __� NAfGN <br />_.__-_..._. <br />INSURED INSURERS: <br />TOM BYSTRY ` <br />DBA: VIDEO ENGINEERING SERVICES Wsuaeac: <br />16875 DONWEST INSURER I <br />Tustin, CA 92780 NaU_RERB <br />___INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 00003902.1453$ REVISION. NUMBER: 4 <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />Imo— ..- _-.. "7AOOL;Sdedi _. .. -- --_.- PDL----- P041CYOfP _._ _---.._.__. ._....—_____ <br />TR TYPE qF INSURANCE POLICY NUMBER p0 LIMITS <br />A <br />G6NERALUAaILiTY <br />Y <br />Y <br />NA104655701 <br />0210112014 <br />0210112015 <br />EACHOCCURRENCE <br />'S"kt3A'CTTfiItENTEO <br />$ 1000,p00 <br />COMMERCIAL GENERAL LIABILITY <br />PREMI ES Es n <br />$ 100.000 <br />CLAIMS -WOE ®OCCUR <br />MEDEXP�q oneRerson�W$ <br />5006 <br />PERSONAL&ADVINJURY <br />$ 1,00gOn 0O <br />_ <br />.GENERALAGGREGATE <br />$ _.2i000,000 <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />i <br />PRODUCTS -COMPIOP AEG <br />$ 1000000 <br />x <br />POLICYI P i LDC <br />VICAR <br />a��� <br />AUTOMOBILE <br />LIABILITY <br />vCO <br />_ <br />COS INED � i� N EL 1 <br />ANYAUTO <br />ALL OWNED SCHEDULED <br />�gT�Y1�V i "' �" <br />Y &J' / <br />�„-. <br />BODILY INJURY IPer parson) <br />AUTOS AUTOS <br />y <br />+' (_lp.'"' <br />.�- <br />BODILY INJURY (Per acdden6)$ <br />NO&OWNED <br />HIREDgUT03 <br />( <br />'�orneY <br />NRbPEA �OAMAOE <br />i $ -_._-- _._... <br />.AUTOS <br />,.` P F : � p <br />Px ,Id ,____�� <br />$ <br />UMBRELLALIAB OCCUR <br />C71 ILJ <br />EACHOCCURRENCE <br />$ <br />.-. <br />EXCESS UAB CLAIM&MADE <br />( <br />�S$1Sta <br />/ <br />AGGREGATE <br />�,- <br />$ <br />D RETENTION$ <br />i <br />I $ <br />WORKERS COMPENSATION <br />I <br />... <br />....s W_ <br />STATU-� <br />_ <br />Y!N <br />( <br />_IWG <br />_.. SOBKk1MlLY .... EEL- <br />..e.e..,.,. <br />MY- <br />PROLOYERB'LIRTNEY <br />PROPBIETORIPARTNDED? UTIVE <br />I <br />E.L EACH ACCIDENT <br />$ <br />BER EXCLUDED? <br />OFFId.Wo, <br />NIA' <br />E.L. DISEASE -EA EMPLOYE <br />$ <br />R <br />Irm, doryln NH) <br />1(yyee, doscdbe under <br />( <br />DESCRIPTI NAP DPERATIGNa below <br />E.L. DISEASE -POLICY LIMIT,$ <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (A1IAeh ACORD 101, Addalaeel Remerhe Schedule, if more apace 1. req"Imd) <br />The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; It officers, <br />employees, agents and representative are named as additional Insureds ("additional <br />Insureds") with regard to liability and defense of suits arising from the operations and uses <br />performed by or on behalf of the named insured. <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />CITY OF SANTA ANA FINANCE & MANAGEMENT SERVICES AGENCY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />PURCHASIN ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 CIVIC CENTER PLAZA M-16 .� �....» <br />Santa Ana, CA 92702 AUTHORIZED REPSIS TIV6 <br />CPF <br />01988.2010 ACORD CORPORATION. All rights reserve <br />ACORD 25 (2010/06) The ACORD name and logo are registered marks of ACORD <br />Printed by CPR on January 27, 2014 at 03:16PM <br />