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Feb-02-04 02:30pm From -DRIVER ALLIANT INS, C <br />9497562713 T-617 P 02/02 F-853 <br />DRIVER -ALLIANT <br />License Number: OC36861 <br />Pbooe (949)1564271 / Fax (949) 756-2713 <br />Certificate Number:047 Dam 2/2104 <br />VENDOR / CONTRACTOR LIABILITY PROGRAM <br />Named Insured: <br />TomBystry / DBA: Video Engineering Services <br />Address: <br />3058 Westbaven <br />City/State/zip; <br />Orange, CA 92865 <br />Additional Insured; <br />City Of Santa Ana <br />Contact Teem: From- <br />02/01/04 TO 02/01/05 <br />Description of Contract: Vidto Tape City Council Meetings <br />Contract Amow;t $45,000.00 <br />COMM&RCIAL GENERAL LIABILITY —NEW OCCURRENCE FORM <br />Gemral Aggregate. <br />S3,000,000, <br />Produem/Complated Operations Limit: <br />$1,000,000. <br />Personal Advertising; <br />S1,000,000. <br />Each Occurrence: <br />S1,000,000. <br />Fire Damage: <br />$ 50,000. <br />Medical Payments; <br />S 5.000 <br />IMPORTANT! <br />Coverages are Limited to described coon'acr. <br />DEDUCTIBLE: $1,000. Each Claim, Including Legal and A4jUSUWnt EVemas <br />ANNUAL PREMIUM. <br />S625.00 Fully Earned at Inception <br />SURPLUS LINES TAX: <br />S 20.31 Fully Earned at Inception <br />POLICY FEE: <br />$ 50_00 Fully Earned at Inception <br />TOTAL <br />S69531 <br />COMPANY: COLONYINSURANCECOMPANY <br />THIS COMPANY BINDS THE XIND(S) OF INSURANCE STIPULATED HEREON. THIS <br />INSURANCE IS SUBJECT TO THE TERMS, CONDITIONS, AND LM TTATIONS OF THE POLICY <br />OF MASTER POLICY #CP3073434 ISSUED TO VENDORS/CONTRACTORS LIABLITY GROUP. A <br />COPY OF THIS POLICY IS AVAILABLE ON REQUEST. <br />THIS CERTIFICATE MAY BE CANCELLED BY THE INSURED BY SURRENDER OF THIS <br />BINDER OR BY WRITTEN NOTICE TO TILE COMPANY STATING WHEN CANCELLATION WILL <br />BE EFFECTIVE_ TIUS CERTIFICATE MAY BE CANCELLED BY THE COMPANY BY NOTICE TO <br />THE INSURED IN ACCORDANCE WITH TIM POLICY CONDITIONS. <br />`,,,,`� <br />AUTHORIZED SIGNATURFJCO RSIGNATURE <br />RE. CHAIX & ASSOCIATES INSURANCE OROKERS ,04C. <br />Licaw Numbm 0726213 <br />1501 WcttcliRDri-% Suim 290,Ncwpan BmCh, CA 92660 <br />PHONE (949)722-4171 / PAX; (949)722.4172 <br />( -1-i G <br />htQ�— <br />