THOMAS BYSTRY DBA VIDEO ENGINEERING SERVICES

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R. Digitally signed by Francine Francine . Il R. Vil lareaI Villareal Date: 2022.01.2808:19:14 08,00, Phone: (714)647-5420 Fax: (714)647-6944 ACOR" CERTIFICATE OF LIABILITY INSURANCE ill DATE (MMIDD/YYYY) 1 01 /26/2022 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. 5000 San Juan Avenue CONTACT Chris Rudolph PHONE FAX A/C No Ext : (916)485-1705 A/C No : (916)485-0198 E-MAIL ADDRESS: ChrIS@trltOr11r1SUrarlCe.COm Fair Oaks, CA 95628 INSURER(S) AFFORDING COVERAGE NAIC# License #: OF41767 INSURERA: Mesa Underwriters Speciality Insurance Co. INSURED TOM BYSTRY INSURER B DBA: VIDEO ENGINEERING SERVICES INSURER C 915 WYCLIFFE INSURER D IRVINE, CA 92602 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: 00003962-9368 REVISION NUMBER: 38 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y MP0004009007964 02/01/2022 02/01/2023 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE F�vl J OCCUR DAMAGE TO PREM SES (E.0.RENTEFence) Fence)$ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY D PRO- JECT LOC �( PRODUCTS - COMP/OP AGG $ 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) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LAB OCCUR EACH OCCURRENCE $ ECLAIMS-MADE AGGREGATE $ EXCESS LAB DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? N / A E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / 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 REP ATIVE )';lSil Mwag7MM2d DMsiun Aw F �40 \'x REVIEWED & APPROVED BY.- v N371F Ill @ 1988-2015 ACORD C h Wsk Management Analyst ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Pri