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DRIVER-ALLIANT <br />Lleense Number: OC36961 <br />Phone (949) 7M4271 / Fax (949) 756-2113 <br />CatiSuteNumber.043 Date: 1/24/05 <br />VENDOR/ CONTRACTOR LIABILITY PROGRAM <br />Named Insured: TOM BYSTRY <br />Address: 3059 WESTHAVEN STREET <br />City/5mte2ip: ORANGE, CA 92963 <br />Additional Insured: CITY OF SANTA ANA <br />ContractTetr. From: 02/01/05TO02/01/06 <br />Description of Contract: VIDEOTAPING CITY COUNCIL MEETINGS <br />Contract Amount: S45,760.00 <br />COMMERCIAL GENERAL LIABILITY— NEW OCCURRENCE FORM <br />Oencrai Aggregate: S1,000.000. <br />p /Completed Operations Limit: 51,000 (100. <br />Personal Advea¢siag: $I,000,000• <br />S1,000.000. <br />Each Occmrma: S 50,0DO. <br />Fire Damage: S 5,000 <br />Medial Payments: <br />rMPORTANTI <br />Coverages are Limited to dea< rbed contract. <br />DEDUCIBLE: $1,000. Each Claim. Including Legal and Adlnatment Expenses <br />ANNUAL VREMMM: $686.00 Fully Earned at Inception <br />SURPLUS LINES TAX: 22.12 Fully Earned At locePtion <br />Fully earned a �ePun <br />POLICY FEE: $ s75&�12 <br />TOTAL <br />COMPANY: COLONY INSURANCE COMPANY TED HEREON, TiiIS <br />THIS COMPANY BINDS THE KIND(S) OF INSURANCE S UKJJ-A <br />INSURANCE IS SUBIECTTO THETffitMS, CONDITIONS,VENDANDCON�CTOARS LIABLITY GROUP. A <br />OF MASTER POLICY #W215216 ISSUED TO VENDOl� <br />COPY OF THIS POLICY IS AVAILABLE ON REQUEST. <br />OFTHIS <br />THIS CERTIFICATE MAY B,IMCEIo �CONRANy THGSWHEN CANERCELLATIONWILL <br />BINDER OR BY 1" TTEIQ TO <br />BE EFFF.CTIVR• THIS CERTIFICATE MAY HE CANCELLED BY THE COMPANY BY NOTICE <br />THE INSUR;"; AC 7 POLICY CONDITIONS. <br />AUTHORIZED SIGNAT[1AE/COUNTE�IGNATURE <br />RE CHALY a, ASSOCIATES INSURANCE HROKEas -INC- <br />kv?ROVEL) AS TO FORM <br />Beare Number: 0726213 .+ <br />41 C.Mm u' Pert, Sulm 310. WFINCA 92606 / <br />PRONE (94917224177 / FAX (949)722-4172 <br />'�.adta Stitt S edy <br />AaaistaaL City Attorney <br />