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AGENCY CUSTOMER ID: 00003962 <br />LOC N: <br />ADDITIONAL REMARKS SCHEDULE Page 2 of 2 <br />AGENCY <br />Triton of Calif Insurance Services, Inc. <br />— <br />NAMED INSURED <br />TOM BYSTRY <br />DBA: VIDEO ENGINEERING SERVICES <br />POLICY NUMBER <br />NA104655702 <br />CARRIER <br />Associated Industries Insurance Company <br />NAIB CODE <br />EFFECTIVE DAM02/0112016 <br />ADDITIONAL REMARKS <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance <br />(continued from Description of Operations) <br />Insured against whom claim is made or sult 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 effect any right which such person or oranization would have as a claimant If not so Included. With respectthe <br />additional Insureds, this Insurance shall not be cancelled, or materially reduced In coverage or limits except after thirty 13O)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 />PRCSA/Adman, <br />Annon Rnn mnmmnnl r(J 2008 ACORD CORPORATION. All rlohis resarved. <br />The ACORD name and logo are registered marks of ACORD <br />Printed by CPR on January 27, 2015 at It: 13AM <br />