PROOF OF INSURANCE (2020) CLOSEDBUFKII-1 OP ID: GAZA
ACOR[?- DATE (MMIDD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 03/13/2019
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(les) must 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 i
certificate holder in lieu of such endorsement(s).
PRODUCER .. .... CONNAMTACT
CT Maria R Garza
Parker General Ins. Services .. -- -- - ._..
CA Insurance License 0545437 PHONE 559-224-8222 II
AEWAIL
DR s m aria oe 24-8277
FQesno, CA93711.............5...., � pa„rke'rinsurance.com
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... _,.,. INSURER AC Colony Company
INSURED V. Bufktn Computer ConsulINSURER 837 N. Linden Avenue .-
Gary
.......
Fresno, CA 93728
,.........
INSURER ._..,.....-.m...._A...,..._ .�
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D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
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 CONTRACT OR 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 ADDL''SUSR POLICY EFF POCKY EXP
TYPE OF INSURANCE -
� ; INS � POLICY NUMBER IMMIODiYYYY'Y I IMMdDDPY'YYYti LIMIT�S�
COMMERCIAL GENERAL LIABILITY jACH OE f0 YtENTLii """"_.”' ....,.,,,. 1,000 00ci
A X • - CLAIMS -MADE X OCCUR X GL0009434.05 03/01/2019 03/01/2020 0(
., .. PREMA ES Ea ssuc idv rr $ 100 �.,......
GENU, AGGREGATE L.... .-
_ IMIT APPLIES PER:
M»_
POLICY PRO-
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OTHER
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
....,..� AUTOS AUTOS
HIRED AUTOS NON -OWNED
__. AUTOS
UMBRELLA LIAR 1 OCCUR
EXCESS S
LIAB, CLAI vIS-MADE
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WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y I N
ANY PROPRIETOMPAR'TNERIEXECUTPVE
OFRCERWMEMSER EXCLUDED" � N t A
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0 Yes, describe under
DESCRIPTION OF OPERATIONS below
4 . J... P„ 4 P .................
......... .......... ., "..,. .
MED EXP (Any one personp
'_$
5,00
RSONAL & ADV INJURY
$
1,000,00(
GENERAL AGGREGATE
$
2,000 00
PRODUCTS - COMPIOP AGG
$
1,000,00
SINGLE LIMIT
$
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BODILY INJURY (Per person)
S
BODILY INJURY (Per accident . .
'dent) $
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UY DANMAGE
dant4
$
EACH 0
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R AGGREGATE
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EL EACH AC,CIDE'NI
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E L I:11'SEAS'E , EA. E'MPLOYEEj $
E L MSEAS�E -POLICY LIMIT
$
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Certificate Holder is named as an additional insured.
CERTIFICATE HOLDER CANCELLATION
CITYEA
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of EI Segundo ACCORDANCE WITH THE POLICY PROVISIONS.
Lili Sandoval
350 Main St. AUTHORIZED REPRESENTATIVE
EI Segundo, CA 90245-'.,.... _
w
O 1988-2014 AC IRD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
101 GL 0009434-05
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED D - OWNERS, LESSEES
OR CONTRACTORS - BLANKET COVERAGE
INCLUDING PRIMARY/ NON-CONTRIBUTORY
AND WAIVER OF SUBROGATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Additional Insured Person(s) or Organization(s)
(Additional Insured):
All persons or organizations as required by a written
contract or agreement with the named insured.
RM
Location(s) of Covered Operations:
Locations as required by a written contract or
agreement with the named insured.
A. SECTION II — WHO IS AN INSURED is amended to include as an additional insured the person(s) or
organization(s) shown in the Schedule for whom you are performing operations when you and such
person or organization have agreed in writing in a contract or agreement that such person or
organization be added as an additional insured on your policy. Such person or organization is an
additional insured only with respect to liability for "bodily injury", "property damage" or "personal and
advertising injury" caused, in whole or in part, by:
1. your acts or omissions; or
2. the acts or omissions of those acting on your behalf;
in the performance of your ongoing operations for the additional insured(s) at the location(s)
designated above.
A person's or organization's status as an additional insured under this endorsement ends when your
operations for that additional insured are completed.
B. With respect to the insurance afforded to these additional insureds, the following additional
exclusions apply:
This insurance does not apply to:
Additional Insured Contractual Liability
"bodily injury" or "property damage" for which the additional insured(s) are obligated to pay damages
by reason of the assumption of liability in a contract or agreement.
Finished Operations at Work
"bodily injury" or "property damage" occurring after:
1. all work, including materials, parts or equipment furnished in connection with such work, on
the project (other than service, maintenance or repairs) to be performed by or on behalf of the
additional insured(s) at the location of the covered operations has been completed; or
2. that portion of "your work" out of which the injury or damage arises has been put to its
intended use by any person or organization.
Negligence of Additional Insured
"bodily injury" or "property damage" arising directly or indirectly out of the negligence of the additional
insured(s).
U156A-0313 Includes copyrighted material of ISO Properties, Inc., Page 1 of 2
with its permission.
101 GL 0009434-05
C. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. Other Insurance is
amended and the following added:
The insurance afforded by this Coverage Part for the additional insured required by a written contract
or agreement with the named insured is primary insurance and we will not seek contribution from any
other insurance available to that additional insured.
D. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 8. Transfer Of Rights Of
Recovery Against Others To Us is amended and the following added:
We waive any rights of recovery we may have against any person or organization because of
payments we make for injury or damage resulting from your ongoing operations or "your work" done
under a contract with that person or organization and included in the "products -completed operations
hazard" if:
a. you agreed to such waiver;
b. the waiver is included as part of a written contract or lease; and
c. such written contract or lease was executed prior to any loss to which this insurance applies.
ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED,
U156A-0313 Includes copyrighted material of ISO Properties, Inc., Page 2 of 2
with its permission.
Computer Consulting and Associates
1374 N. Linden, Fresno, CA 93728 (559) 917-0350
As of January 2019, Gary V. Bufkin Computer Consulting (GVBCC) has made a commitment to become a
Green Company. In doing so, GVBCC has discontinued any use of company vehicles in its performance
of its duties.
GVBCC and its associate's takes great pride in helping Californian reach its goals for a Greener California.
This letter is to document that GVBCC no longer has auto liability and doesn't drive company
vehicles on behalf of the city of EI Segundo.
Thank You
�varyV. Bufkin
Owner
Gary V. Bufkin Computer Consulting and Associates
Fresno, California
Specializing in custom software, database and web development for the Government Sector since 1994
CITY OF EL SEGUNDO
WORKERS' COMPENSATION DECLARATION
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SUBJECTS AN EMPLOYER TO CRIMINAL PENALTIES
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000),
IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED
FOR IN LABOR CODE § 3706, INTEREST, AND ATTORNEY'S FEES.
I affirm under penalty of perjury under the laws of California one of the following declarations:
(_) I have and will maintain a certificate of consent of self -insure for workers' compensation, issued by the Director
of Industrial Relations as provided for by Labor Code § 3700 for the performance of the work set forth the agreement
with the City of EI Segundo
Policy No.
(__) I have and will maintain workers' compensation insurance as required by Labor Code § 3700 for the performance
of the work for which the agreement with the City of EI Segundo is executed. My workers' compensation insurance
carrier and policy number are:
Carrier Policy Number Expiration Date
Name of Agent Phone #
�I certify that, in the performance of the work set forth in the agreement with the City of EI Segundo, I will not
employ any person in any manner so as to become subject to the workers' compensation laws of California, and
agree that, if I should becomeubject to the orkersL��npensation provisions of Labor Code § 3700 I must
immediately comply with those provisions or h'a n, walTa*k<ratically become void.
Signature of Appli nt i� t Date
Print Name —��
Agreement for:
Dated:
Reviewed b