Loading...
PROOF OF INSURANCE (2022) CLOSED (2)CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 10/13/2021 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(ies) must be endorsed. If SUBROGATIONIS 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 certificate holder in lieu of such endorsement(s). _...._._---------------------------------------------------------------------------------------------_ PRODUCER CONTACT NAME: JOE PARKER INSURANCE SERVICES INC ......•••�vcNN (559) 224-8222 I (559)224-8277 51135540 Ed).(AC, No): PO BOX 5411....... ........................... ..... _- E-MAIL ADDRESS: FRESNO CA 93755 �— INSURER(S) AFFORDING COVERAGE NAIL# INSURER A: Sentinel Insurance Company Ltd. 11000 .� INSURED...........................................�--- INSURER B :-........... GARY V. BUFKIN DBA GARY V. BUFKIN COMPUTER .--- INSUURER : ............................. RERCC CO_.........................................................................._._..............._. 1374 N LINDEN AVE INSURER D; FRESNO CA 93728-2320 INSURERE: ........ .............................. ......................................................................- 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. ADDL SUBR TYPE 0 _..... .............. . POLICY EFF POLICY E)Cp F INSURANCE POLICY NUMBER LIMITS LmTR. INSR WVD ... COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLd'AIMS44ADE OCCUR $1,000,000 ..... Pf 9MISES (Fa_or;.wmapca} ITITITITm .ITITITITIT. . X General Liability MED EXP (Any one person) $10.000 ........................................ A X 51 SBABA2851 03/01/2021 03/01/2022 PERSONAL BADVINJURY $1,000,000 ... ................... --- GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- � POLICY PPRO- II - �W LOC PRODUCTS - COMP/OP AGG $2,000,000 OTHER .......... ........ ......................... .._._._....m...........-..-.... AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT a av ident .................... ANY AUTO BODILY INJURY (Per person) ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) HIRED NON -OWNED PROPERTY DAMAGE AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS- AGGREGATE MADE DE D RETENTION $ WORKERS COMPENSATION ........ PER .............. O'fH- AND EMPLOYERS' LIABILITY TAT,ITE �!? _________________� ANY YIN E.L. EACH ACCIDENT OFFICER/MEMBER -R/MEMBER EXCLUDED? NIA ELµDISEASE -EA EMPLOYEE ----........ (Mandatory in NH) LLL��� ------------------- ICE If yes, describe under E,L. DISEASE -POLICY LIMIT DESCRIPTION OF OPERATION$ below___ ACORD101,AdditionalWRemarks .....m... ... DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES ( Schedule, may be attached if more space is required) Those usual to the Insured's Operations. Certificate holder is an additional insured per the Business Liability Coverage Form SS0008, attached to this policy. -------------------------------------- -..................... .... ..... ....-- CERTIFICATE HOLDER CANCELLATION'. City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 350 MAIN ST BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED EL SEGUNDO CA 90245-3813 IN ACCORDANCE WITH THE POLICY PROVISIONS. ....................................................................................... AUTHORIZED REPRESENTATIVE .. m........................................... © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 101 G L 0009434.04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - BLANKET COVERAGE INCLUDING PRIMARY / NON-CONTRIBUTORY AND WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: COMM ERCIAL-GENERAL-L-IABIL-IT-Y-GOVERAGE PART SCHEDULE _ Additional diti Insurens) anizon- Name of AddiYed PrsoorOr at� lns g _ ion—( s}— Locations of Covered Operations, All persons or organizations as required by a written Locations as required by a written contract or contract or agreement with the named insured. 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 fumished 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 0009434-04 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 El Segundo. Thank You dry V, 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 El 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 El 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 performan t e work set forth in a agreement with the City of El Segundo, I will not loy any person in any man er so as to mew, tot orkers' compensation laws of California, and agree that, if I should become s b' t he'r&rker om atipi� "Df Labor Code § 3700 1 must immediately comply with those pr _ autos e void. Signature of Appli t* �" •�" � " � Date Print Name Agreement for: Dated: 10/14/21 ry ,� Reviewed by: Hank Lu Risk Manager