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CERTIFICATE OF LIABILITY INSURANCE I D^EM 1—YY'Y) <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(ies) must be 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 />PRODUCER <br />NnmNE s" <br />Chris Rudolph <br />Triton of Calif Insurance Services, Inc. <br />PHO <br />_ <br />FAX <br />2332Auburn Blvd <br />No Ext: <br />(91s)48s-nos Alc No: (916)485-0198 <br />E-MAILAID <br />ADDRESS: <br />chris@tritoninsurance.com <br />Sacramento, CA 95821 <br />License #: OF41767 <br />_ <br />INSURER(S) AFFORDING COVERAGE <br />NAIC# <br />INSURER A: <br />Associated industries Insurance Company__ <br />INSURED <br />TOM BYSTRY <br />INSURERS: <br />DBA: VIDEO ENGINEERING SERVICES <br />INSURERC: <br />16875 DONWEST <br />INSURERD: <br />Tustin, CA 92780 <br />INSURERE: <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: <br />00003962.14535 <br />REVISION NUMBER: 7 <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 />INBR <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />SUBR <br />POLICY NUMBER <br />POLICY EFF <br />MMIDDIYYVY <br />POLICY EXP <br />MMIDDNYVY <br />LIMITS <br />A <br />GENERAL LIABILITY <br />Y <br />Y <br />' NA104666702 <br />02/01/2016 <br />02/01/2016 <br />EACH OCCURRENCE <br />1,000 000 <br />x COMMERCIALGENERAL LIABILITY <br />DAMAGE TO RENTED <br />PR EMISESEeoccurrence <br />__$ <br />$ 100000 <br />CLAIMS -MADE n OCCUR <br />MED EXP (Any one person)_ <br />$ 5 000 <br />PERSONAL&ADV INJURY <br />$_ 000000 <br />_ <br />_ <br />GENERAL AGGREGATE <br />_1 <br />i1$ _ 1,000 ,000 <br />GEN'LAGGREGATE LIMIT APPLIES PER: <br />PRODUCTS -COMPIOP AGG <br />$ 1, 000,000 <br />xl POLICY JECTPRC- LOC <br />$ <br />AUTOMOBILE <br />LIABILITY <br />COMBINEDSINGLE LIMIT <br />His eccitlent <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />HIRED AUTOS NON OWNED <br />p <br />Reviewed <br />by. <br />- <br />$ <br />BODILY INJURY (Per accident) <br />(Per acciden DAMAGE-- <br />$ <br />.7 <br />UMBRELLA LIAB <br />OCCUR <br />I <br />EACH OCCURRENCE <br />$ <br />$ <br />EXCESS LIAB <br />CLAIMS -MADE <br />AGGREGATE <br />DED I I RETENTION$ <br />Cl levas$ <br />_ <br />WORKERS COMPENSATION <br />ANOEMPLOYERS'LIABILItt YIN' <br />i <br />Rl^, A A <br />R' <br />rn' <br />NC STATU- OTH- <br />iCRY LIMITS ER <br />_. <br />ANY PROPRIETORIPARTNERIEXECUTIVE <br />"'�' `/' ` <br />1f,ln <br />EL EACH ACCIDENT <br />$ <br />OFFICERIMEMBER EXCLUDED? ❑ <br />NIA <br />$ <br />(Mandatory In NH) <br />EL DISEASE - EA EMPLOYEE <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE -POLICY LIMIT <br />$ <br />DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is requl®d <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. With respect to claims arising out of the operations and uses performed by <br />or on behalf of the named insured, such insurance as is afforded by this policy is primary and is not additional or contributing <br />with any other insurance carried by or for the benefit of the additional insureds. This insurance applies separately to each <br />continued on ACORD 101 Additional Remarks Schedule) <br />CERTIFICATE HOLDER CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />CITY OF SANTA ANA, IT'S OFFICERS, EMPLOYEES, AGENTS AND <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />REPRESEN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 CIVIC CENTER PLAZA M-16 <br />AUTHORIZED REPRESENTATIVE <br />Santa Ana, CA 92702 <br />(CPR) <br />©1988-2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010106) The ACORD name and logo are registered marks of ACORD <br />Printed by CPR on January 27, 2015 at 11:13AM <br />