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X-,')Zo(o- 0e13 <br />DRIVER -ALLIANT <br />License Number: OC36861 <br />Phone (949) 756-0271 / Fax (949) 756-2713 <br />Certificate Number:035 Date: 2/9/06 <br />VENDOR / CONTRACTOR LIABILITY PROGRAM <br />Named Insured: VIDEO ENGINEERING SERVICES—THOMAS E. BYSTRY <br />Address: 3058 NORTH WESTHAVEN ST. <br />City/State/Zip: ORANGE, CA 92865 <br />Additional Insured: CITY OF SANTA ANA <br />Contract Term: From: 02/01/06 TO 02/01/07 <br />Description of Contract: <br />Contract Amount: <br />VIDEO PRODUCER <br />$63,400 <br />COMMERCIAL GENERAL LIABILITY — NEW OCCURRENCE FORM <br />General Aggregate: <br />$1,000,000. <br />Products/Completed Operations Limit: <br />$1,000,000. <br />Personal Advertising: <br />$1,000,000 <br />Each Occurrence: <br />$1,000,000. <br />Fire Damage: <br />$ 50,000. <br />Medical Payments: <br />$ 5,000 <br />IMPORTANTI <br />Coverages are Limited to described contract. <br />DEDUCTIBLE: $1,000. Each Claim, Including Legal and Adjustment Expenses <br />ANNUAL PREMIUM: <br />$1,902.00 Fully Earned at Inception <br />SURPLUS LINES TAX: <br />$ 60.39Fully Earned at Inception <br />POLICY FEE: <br />$ 50_00 Fully Earned at Inception <br />TOTAL <br />$2,012.39 <br />COMPANY: COLONY INSURANCE COMPANY <br />THIS COMPANY BINDS THE KIND(S) OF INSURANCE STIPULATED HEREON. THIS <br />INSURANCE IS SUBJECT TO THE TERMS, CONDITIONS, AND LIMITATIONS OF THE POLICY <br />OF MASTER POLICY #GL3309213 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 THE COMPANY STATING WHEN CANCELLATION WILL <br />BE EFFECTIVE. THIS CERTIFICATE MAY BE CANCELLED BY THE COMPANY BY NOTICE TO <br />THE INSURED IN ACCORDANCE WITH THE POLICY CONDITIONS. <br />AUTHORIZED SIGNATUREICOUN RSIGNATURE <br />R.E. CHAIR & ASSOCIATES INSURANCE BROKERS,INC. <br />License Number 0726213 <br />41 Corpoute Park, Suite 310, Irvine, CA 92606 <br />PHONE (949)7224177 1 FAX: (949)7224172 �� <br />