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TE <br />(MMI <br />ACk:?R X° CERTIFICATE OF LIABILITY INSURANCE o011271 or2015 <br />�' 01/27/ <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 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 />certificate holder in lieu of such ondosement a . <br />PRODUCER CONTACT <br />NAME. _Chris Rudolph <br />Triton of Calif Insurance Services, Inc. -PRONE _ - — _ FAX <br />N Elul' (916)486-1705 FAX Nm1 (918)485.0198 <br />2332 Auburn Blvd EMAIL <br />Sacramento, CA 95821 ADDRESS_ chris@trltoninsurance.com _ <br />NSURERje)APFORDIND COVERAGE_ NAICrILicense #t OF41767 -- <br />INSURERA. <br />Associated lndgsirles lnsuranE_04mpany. _ _ __ <br />INSURED — <br />TOM BYSTRY !@sunERE: <br />DBA: VIDEO ENGINEERING SERVICES INSURERC _ <br />16875 DONWEST INSURERU <br />Tustin, CA 92780 INSURER <br />INSURER F. <br />CrTVFRARFR CERTIFICATE NUMBER (IM039E2.14535 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 MAY BE 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 />INSR__.___.-_..._...__—ADOC SUSR—.—__...—__.—_--_—..PULICYFPPIP6LIOYf%P — <br />LR,. TYPE OF INSURANCE POLICY NUMBER MIDOrTY IDIVYYY LIMITS <br />A GENERALLIABILITY <br />Y Y <br />NA104655702 <br />0210112016 <br />02101/2016 <br />EACH <br />a <br />�%f, LCDMMFRCIAL GENERAL LIABILITY <br />MACETOOCCURRENCE <br />DAMADETO RENTED <br />PREMIiF$(Em mceprrmnceJ <br />_1,100,900 <br />$ __ 1QQ,000 <br />CLAIMS MADE n OCCUR <br />MEO EXP (Any one peen) <br />5 QQQ <br />PERSONAL 4AOV INJURY (S <br />GENERAL AGGREGATE <br />_,1,000,00Q 11 <br />Is 1,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />_P_ROOUCTS�COMPIOPAGG <br />_ <br />$ _. 1,000,000 <br />X PoUCY PE O LOC <br />$ <br />AUTOMOSILELIABILITV <br />COMBINED SINGLE LIMIT <br />1Ee MINED <br />S <br />ANY AUTO <br />SODILYINJU RY(Pm, pmlamn) <br />S <br />AUTOWNED SCHEDULED <br />L <br />BgDILY INJURY (PereacMenQ <br />$ <br />PROPERTY DAMHGE <br />$ <br />NONAWNEO <br />i <br />Reviewed <br />by: <br />MREDAUTOS AUTOS <br />M <br />(Pet mpOtlent)___ <br />4 <br />UMBRELLA LIAR OCCUR <br />I��^(r" <br />'� E_ACHOCCURRENCE <br />i EXCESS LIAR_= CLAIMS-MADEI <br />/ <br />AGGREGATE <br />{IS <br />[� <br />lli IPA (.I I <br />DED RETENTIONS <br />�_ <br />j WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />r'� /�L //— <br />PRCSA/A <br />min. <br />WC STATW r, <br />---�TORYSIMII31_ ERA <br />TOTH <br />_.. <br />ANY PROPRIETCRIPARTNEWEXECUTNE ❑ <br />NIA <br />EL EACH ACCIDENT <br />�$_ <br />OFiICERIMEMSER EXCLUDED'? <br />( <br />(Mend®Im,y In NH) <br />E L DISEASE � EA EMPLOYE <br />3 <br />e yyes deud5e wdar <br />DESCRIPTION OF0 ERATIONSbeIYW <br />I <br />( <br />EA. DISEASE POLICY LIMY <br />_ <br />I i I <br />i <br />I <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Atlamb AGDRD 101, gdVilim"el Rema,hm SmaegVle, artwn apgme le Yegvirodl <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 />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-18 <br />Santa Ana, CA 92702 <br />1 AUTHORMEDREPRE�VE <br />9 <br />ACORD 26 (2010/05) The ACORD name and logo are registered marks of ACORD <br />Printed by CPR on January 27, 2015 at 11:13AM <br />