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AGENCY CUSTOMER ID: 00003962 <br />LOC M <br />ADDITIONAL REMARKS SCHEDULE Page 2 of 2 <br />AGENCY <br />Triton of Calif Insurance Services, Inc. <br />NAMEDINSURED <br />TOM BYSTRY <br />DBA: VIDEO ENGINEERING SERVICES <br />POLICY NUMBER <br />NA104656702 <br />CARRIER "IC CODE <br />Associated Industries Insurance Company <br />eFFecTwe DATe:02/0112015 <br />ADDITIONAL REMARKS <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: Certificate of Liability tnsurance <br />(continued from Description of Operations) <br />Insured against whom claim is made or suit is brought except with respect to the comany's limits of liability. The inclusion of any person or <br />organization as an insured shall not affect any right which such person or oranization would have as a claimant if not so included. With respect the <br />additional Insureds, this insurance shall not be cancelled, or materially reduced In coverage or limits except after thirty (30)days written notice has <br />been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701. <br />Reviewed by: <br />Silvia Cuevas <br />PRCSAIAdmin, <br />ACORD 101 (2008101) 02008 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />Printed by CPR on January 27, 2015 at It: 13AM <br />