THOMAS BYSTRY DBA VIDEO ENGINEERING SERVICES

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o19111ty191ed by Fancne R. Francine R. Villareal Villareal Date :2021.012] 17 0059-08'00' Phone:(714)647-5420 Fax:(714)647-6944 ACORa CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDIYYYY) 01/27/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Triton of Calif Insurance Services, Inc. CONTACT NAME: Chris Rudolph PHONE AIC No Ext: (916)485-1705 FAX No: (916)485-0198 5000 San Juan Avenue NDDRESS: chris@tritoninsurance.com Fair Oaks, CA 95628 INSURER(S)AFFORDING COVERAGE NAICIt License #: OF41767 INSURER A: Mesa UnderWdtersSpeciality Insurance Co. INSURED TOM BYSTRY INSURER B: INSURER C: DBA: VIDEO ENGINEERING SERVICES INSURER D: 915 WYCLIFFE INSURER E: IRVINE, CA 92602 INSURER F: COVERAGES CERTIFICATE NUMBER: 00003962-9368 REVISION NUMBER: 35 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRPOLICY R TYPE OF INSURANCE INSD WVD SUB' POLICY NUMBER EFF MWDD YYYY POLICY EXP MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y MP0004009007169 02/01/2021 02/01/2022 EACHOCCURRENCE $ 1,000,000 CLAIMSMADE EXI OCCUR PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1000000 AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2000000 GEN'L X POLICY JECT LOC PRODUCTS -COMP/OPAGO $ 2,000,000 $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ DAMAGE Per accident $ HIRED NONOWNEDPROPERTY AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMSMADE DED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS 'LIABILITY YIN PER OTH- STATUTE ER EL. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED' NIA EL.DISEASE -EAEMPLOYE $ (Mandatory in NH) fyas desrnbeunder DESCRIPTION OF OPERATIONS below EL.DISEASE -POLICYUMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents and representatives are named as additional insureds per CG2010 attached to this policy. The insurance is primary and non-contributory. Certificate of Insurance shall provide thirty (30) day prior written notice of cancellation City of Santa Ana Risk Management Division 20 Civic Center Plaza, 4th Floor SANTA ANA, CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED ©1988-2015 ACORD CO ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Printed by CP Rime Mrenagnnent Diaisian REVIEWED&APPROVED BY: '� Risk Management Analyst