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ACC7,w " CERTIFICATE CIF LIABILITY INSURANCE DATE (MMPDp fYYY)
<br />�II�, .-'' 01 /1'9/2016
<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 />certificate holder in lieu of such endorsement(s).
<br />PRODUCER CONTACT
<br />NAME: Chris Rudolph
<br />Triton oft Calif Insurance Services, Inc. PHONE EA): (916)485-1705 �P� No):
<br />(sts)a85-oisal
<br />�2332 Auburn lB� Blvd E-MAIL
<br />Sacramento, CA 9'S821 ADDRESS: Chris@tntoninsurance.com
<br />SLicensern: o, CA 9,5 INSURER(S) AFFORDING COVERAGE NAIC 1!
<br />INSURERA: Security National Insurance Company
<br />INSURED INSURER B
<br />TOM BYSTRY i ,
<br />DBA: VIDEO ENGINEERING SERVICES IlusuRERc:
<br />16876 DIOANWESTINSURER_[?
<br />INSURERS:
<br />Tustin, CA 92780
<br />INSURER F
<br />fit-VFRAnF.R rFRTIFIrATF hIIIMRlI nnnnngA9_1AA.3K RFVISION N'I]MIIRFR• 7n
<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 CONTRACT OR 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 />INSti.. TYPE OF INSURANCE. _. ADDL SU�BR ........ POLICY EFF POLICY E7CP
<br />LTR I S. V POLICY NUMBER MM14OlYYY'Y MM1OruYYYY
<br />LIMITS
<br />A GENERAL LIABILITY Y Y NA104655703 0210112016 02101/2017
<br />EACH OCCURRENCE $ 1,000,000
<br />}{ COMMERCIAL GENERAL LIABILITY
<br />DAMAGE 7O RENTED
<br />PREMISES (Ea occurrence} $ 50,000
<br />'.. CLAIMS -MADE .ic_ OCCUR
<br />MED.EXP (Any one person) $ 5,000.......
<br />PERSONAL & ADV INJURY ., $ 1,000,000..
<br />GENERAL AGGREGATE $ 1..,000,000..
<br />GEN'LAGGREGATE LIMIT APPLIES PER '.:..
<br />PRODUCTS COMPIOPAGG.._ $ 1.,000,000
<br />X POLICY JECPRO- _ LOC
<br />_ $
<br />'.... AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />(Ea eccdendL_ $
<br />ANY AUTO
<br />BODILY INJURY (Per person) $
<br />ALL OWNED SCHEDULED @a
<br />BODILY INJURY (Per accident) $
<br />AUTOS AUTOS
<br />NON -OWNED
<br />HIRED AUTOS AUTOS -y,t
<br />PROPERTY DAMAGE $
<br />er a„ccldent)
<br />P, .,
<br />_. .....
<br />UMBRELLA LIAR ,ryry,, .mA
<br />OCCUR
<br />EACH OCCURRENCE $
<br />....
<br />EXCESS LIAR CLAIMS MADE ��, . 9'.`"`
<br />AGGREGATE $
<br />_. a
<br />_. _ . ....
<br />DED._ RETENTION
<br />$....
<br />WORKERS COMPENSATION \\g I`
<br />AND EMPLOYERS' YfN ,(j�y`d
<br />WC STATU- OTH-
<br />TORY LIMITS.. ER....
<br />ANY PROPRIETORfPARTNERfEXECUTIVE *
<br />E L EACH ACCIDENT $
<br />OFFICERMEMBER EXCLUDED? N/A
<br />(Mandatory in NH)
<br />E L DISEASE - EA EMPLOYEE $
<br />If yes, describe under
<br />"
<br />DESCRIPTION OF OPERATIONS below
<br />E L. DISEASE - POLICY LIMIT $
<br />DESCRIPTION OF OPERATIONS i LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
<br />The City of Santa Ana, 20 Civic Center P'Ilaza, 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
<br />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 />CITY OF SANTA ANA, IT'S OFFICERS, EMPLOYEES, AGENTS AND
<br />REPRESEN
<br />20 CIVIC CENTER PLAZA M-16
<br />Santa Ana, CA 92702
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED
<br />1988-2010 ACORD CORPORATION. All rights reserved,
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />Printed by CPR on January 19, 2016 at 10:04AM
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