Laserfiche WebLink
A 6R& CERTIFICATE OF LIABILITY INSURANCE <br />DATEIMMIDDIYYYY) <br />lbl�01/3012013 <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />ONTACT <br />NAME: Am Rudolph <br />Triton of Calif Insurance Services, Inc. <br />PHONE a [916J485-1705 Fae,Not:_(916)465-0198 <br />2332 Auburn Blvd <br />E-MAIL qm trito <br />ADORES: Y� ninsurance.com <br />Sacramento, CA 95821 <br />License #: OF41767 <br />INSURERIS) AFFORDING COVERAGE MAIC N <br />DAWAUL TO RENTED <br />PREMISE$ (Ee oC rreocel S 100,000 <br />CLAIMS -MADE [Al OCCUR <br />INSURER A: Assgciated Industdos InsuranceCompany <br />_ <br />INSURED <br />INSURER 6: - <br />TOM BYSTRY <br />MEP EXP (Any one person) $ 5,000 <br />DBA: VIDEO ENGINEERING SERVICES <br />IISURERC: _ <br />16875 DONWEST <br />INSURER D: <br />INSURER E: <br />Tustin, CA 92780 <br />INSURER F <br />COVERAGES CERTIFICATE NUMBER: 00003962-0 REVISION NUMBER: 3 <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS <br />!NSR <br />LTR TYPE OF INSURANCE <br />ADDL <br />PURCHASI N <br />POLICY NUMBER <br />POLICY EFF <br />MWD <br />POLICY EXP LIMITS <br />MIWDDIYYYY <br />A GENERAL LIABILITY <br />Y <br />Y <br />NA104655700 <br />02/01/2013 <br />02/01/2014 EACH OCCURRENCE $ 1,000,000 <br />X COMMERCIAL 3ENERAL LIABILITY <br />DAWAUL TO RENTED <br />PREMISE$ (Ee oC rreocel S 100,000 <br />CLAIMS -MADE [Al OCCUR <br />MEP EXP (Any one person) $ 5,000 <br />PERSONAL & ADV INJURY $ 1,000,000 <br />GENERAL AGGREGATE $ 1,000,000 <br />GEN L AGGREGATE LIMIT APPLIES PER, <br />PRODUCTS - COMPIOP AGG $ 1,000,000 <br />X POLICY PRO- 7LOC <br />$ <br />AUTOMOBILE LIABILITYBINED <br />SINGLE LIMIT <br />Ea acadent <br />BODILY INJURY (Perperson) S <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />j <br />BODILY INJURY (Per aCadenp $ <br />. AUTOS AUTOS <br />NON -OWNED <br />PROPERTY DAMAGE $ <br />Peracadent <br />HIREDAUTOS _ AUTOS <br />$ <br />UMBRELLA LAB I _ OCCUR <br />EACH OCCURRENCE $- <br />AGGREGATE $ <br />EXCESS LIARCLAIMS-MADE <br />$ <br />I DEC) RETENTIONS <br />WORKERS COMPENSATION <br />WC $TATI. U• :OTHER- <br />AND EMPLOYERS' LIABILITY Y I N <br />ANY PROPRIETORiPARTNERIEXECUTIVE <br />E.L. EACH ACCIDENT S <br />OFFICER/MEMBER EACLUDEDI ❑ <br />IMandatory inNH) <br />NIA <br />E. L. DISEASE - EA EMPLOYE $ <br />E.L. DISEASE - POLICY LIMIT S <br />It yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES IAlach ACORD fol, Addt%onal Remarks Schedule, it more space is required) <br />The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, C21111`01mia 92701; it officers, (� <br />employees, agents and representative are named as additional insureds ("additional AS <br />insureds") with regard to liability and defense of suits arising from the operations and uses 19 <br />performed by or on behalf of the named insured. 4'�O� <br />S.0 <br />�oCrey <br />0M P� <br />CERTIFICATE 44nLDFR CANCELLATION <br />CITY OF SANTA ANA FINANCE & <br />SHOULD ANY OF THE ABOVE DESCRIBED Pd CIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, N9TtaE WILL BE DELIVERED IN <br />MANAGEMENT SERVICES AGENCY <br />ACCORDANCE WITH THE POLICI( PROVISIONS. <br />PURCHASI N <br />Z, <br />AUTHORIZEPREPRESENTA _ - <br />20 CIVIC CENTER PLAZA M-16 <br />Santa Ana, CA 92702 <br />- AAR <br />©1988-2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD <br />Printed by AAR on January 30, 2013 at 09:45AM <br />Ir <br />