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PROOF OF INSURANCE (2018 - 2018) CLOSED BUFKI-1 OP ID: KC '4`ORo CERTIFICATE OF LIABILITY INSURANCE 1 DATE 04/18/2017 Y) 04118/2017 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 certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Par er General Ins.Services CA Insurance License 0545437 PHONE Nv.FX11; Q,(n t; N41 5 NAME: oe F. 559-224-8222 FAX 59 224-8277 Parker 2 5094 N.Fruit,#101 1:MAIL (Fresno,CA 93711 ADDRESS: INSU,RE.RAFFORDING COVICRAG,i§l .......................................-..,,,,,... . C# .., NAI^------., .,,......... mm .....,,, ... ...... .... INSURER A:Colony Insurance Company______,,,,..,. .... .. — INSURED Gary V. Bufkin Computer INSURER B: Consulting I BNsuRER c 1374 N. Linden Avenue Fresno,CA 93728 INSURER 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 igSk" ........�TYPE OF INSURANCE ..... .'d�titSC.,�SUOR .,. ..�����.PbUt".f-itf+�"..-� POLICY kmo ,.._-..,__. Ngqjpp(0, POLICYNUMBER IMMJDDPYYYYI IMM/DDIYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY - EACH OCCURRENCE_ $ 1,000,000 occuR X GL000943403 03!0112017 0310112018 I ...._.... CLAIMS-MADEX...,) �?RFMMS�E-SAC�r,Bcu��wLrnM) „,$, 100,00 MED EXP(Any one person) S 5.00 PERSONAL&A......................R __... _ DV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY ]PE� � LOC PRODUCTS-COMP/OP AGG $ 1,000,000 - gg .__. II OT B°iE R. S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT i$ AUT „(Ery r�e,�,uti�gnl(,,,, _ ANY AUTO BODILY INJURY ALL OWNED I AUTOS �AUTOS BODILY INJURY(Per acct denq $ HIRED AUTOS NON-OWNED LED Pq r F c.B,' ..., AUTOS $ NON-OWNED PR4B1!IR'BeYIBP1AMAGE �$ P LA LIAR V $ I!p OCCUR EACH OCCURRENCE EXCESS G TE $ LIAB DEDI RETENTION$ CLAIMS-MADE AGGREGATE I pp $ I AND EMPLO ERTLIABILITY ,,,,,,,,,,,,,,CilfJul;Br„P CERIN B �I4,,L Itory"in H)EXCLUDED � E L DISEASE EA EMPLOYE I $ (Mandatory In IL ^_�,� E,�$ yy PRROPMETORg,describe deARTNER/E7 ECUTIVE NIA E L EACH ACCIDENT �.......... l:;,SCRIP"I'ION Or t:kPCRA'!IONS Lru:iltm I E L DISEASE-POLICY LIMIT !,$ N DESCRIPTION OF OPERATIONS/LOCATIONS/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 CITYE-1 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 I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD 101 GL 0009434-03 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS,S, LESS S 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 ,Ary MW Name of AdditionalInsured Person(s)or Organizations) (Additional Insured): Location(s�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 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 0009434-03 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. Oct 31 2017 12:42 HP Fax page 4 FARMERS Personal Umbrella Declaration Page INSURA" E iowuomuumnii;uu 1,o,1;IIIelmuuuueWim,wwitl 'll,fii i„A',e auuu i,imau�ur.wn,i��„„;,wu.,,�mi+u„�di.,WWwelauuup,.md �d�bY� I,imi1uA,;udniuuiu i1iimuu.au1iu 111,11111111111,m,mu,WIN iliwely I”III aO 1111 wIihwWv I i I"iIII u;u, w.III,u, , PollcyNumber: 60559-16-27 Premiums(item I) � F ective. 1/5/2017 12:01 AM .,....Poll Icy .»tttitcl�a.....»......... I............... . 0 '"”' ' $26266.t)0 Expiration: 1/5/2018 12:01 AM Named Insured(s):wary Bufkin This is not a bili. 1374 N Linden Ave Your bill with the amount due will be mailed separately. Fresno,CA93728-2320 e•rrsoil garyb@psnw.com Address(es): Underwritten By. Truck insurance Exchange 6301 Owensmouth Ave. Woodland Hills,CA 91367 Rafted Exposures(Item 2) ExposureTypeQuantity Exposure Type Quantity Owner Occupied Residence _.... _...... _.., _._.._ ..__ 1 Ilaatorized Vehicle .___. mm .._ _,._. .._..,.I Schedule of Underlying Insurance(item 3) You have told us you have underlying insurance policies with liability limits listed betow,if the underlying policies terminate or the liability limits are less than,shown below,In the event of a covered toss we will only pay those damages we would have paid It the limits and policies were in place as scheduled.You must keep the coverages and limits below In effect to avoid gaps in your protection. Limit of Insurance Insurance Carrier _ _Policy!^+!_umber .Coverage (in thousands of dollars) Mid•Centu,", lnasurance..om an .. . it33i1t15t14Q ._..__. • � taL-iabality _. _. __...... _._....._ ���� p y �� _.. `250/5006100 Fire Insurance Exchange 9'35520422 .... ... .. ...Homeraww. ... 300 . Homeowner 304 1374 N Linden Ave,Fresno,CA Umits(item 4) Limit Limit _ Coverage e .,. ._.. .„_..,...,_....._........__..._.._{..___... . ..,_2 Coverage over 9 ,yla each occurrence 9 GeneralLiabDity $1,000,000 Uninsured/Underinsured Motorist Not Covered Retained Limit $250 Driver-irif ormation Name Driver Status Gary Bufkin Covered oa116141661 uu, 111IIIIu111uiuIYil; G, I Ill iwuw ww ,VV 111111111111411111p I roo;w wuu farmers.com Policy No. 60559-16-27 Questions? Manage your account: Lail your agent fiNicnle terno Insurance Co to wIaw.farmers.com to access Agency Inc at(559)9 -1 or entail your account any time! derno tarmersargent.corn 51 1st Edition 415 11/S/2016 Page t of 2 Oct 31 2017 12:42 HP Fax page 5 Declaration Page(continued) Ylltllllln!II,YaI UW�l�l�i4�!ulununmW IWWwYWVJiYWWM'YWwWWpilAWntMWYYpV'uuuNWViW IY nI�IIIWWI'JIW@,LIII14Yliul�iuhV",npl,.Yluu!Jll�li�hlla .1.%" uWAli,,i,iiiMU1IIIIWY iii dihIIIIIIIIII�u !l!l I ilVInIuIIII�YiI�IYIIII'IJ�i.IIILIIIY,WIYJIWII W'.IWIIIIIWIIIIIIW In WIlYL6W81W WYYMh Policy and Endorsements This section lists the policy form number and any applicable endorsements that make up your insurance contract.Any endorsements that you have purchased to extend coverage on your policy are also listed in the coverages section of this declarations document: 56-52803rd ed.;CA029A 1 st ed.;CA103A 1st ed.;E01171st ed.;E01181st ed.;J6951 A 1 st ed.;25-8531 10-12 Other Information • The Attorney-In-Fact(AIF)or Management Fee for your renewed policy will never exceed 20%of the policy's premium's and will be paid out of the premiums.You may,wish to consider this Information in deciding whether to acceptor decline this offer to renew your policy. *Information on Additional Fees The"Fees'stated in the"Premium/Fees"section on the front apply on a per-policy,not an account basis.The following additional fees also apply: 1, Service Charge per installment(Inconsideration of our 2. Late Fee:$10.00(applied per account) agreement to allow you to pay in installments): 3. Returned Payment Charge:$25.00(applied per check, For Recurring Electronic Funds Transfer(EFT) and fully electronic transaction,or other remittance which is not enrolled online billing(paperless): $O.OD(applied per honored by your financial institution for any reason including account) but not l invited to insufficient funds or a closed account) For other Recurring EFT plans:$2.00(applied per account) 4. Reinstatement Fee:$0.00(applied per policy) For all other payment plans:$5.00(applied per account) One or more of the fees orcharges described above may be If this account is for more than one policy,changes in these fees are deemed a part of premium under state law. not effective until the revised fee information is provided for each policy. Countersignature Authorized Representative ..wIW,»�'.IIIIIIIII�IIYIYo��,WIIIIIu�YI���ollll.!!Iu!���������!! II��!IIIIIIIIIII!I!I!I!I!III�IIY III�����I�I������III , Illlllllllllllllllllll�ll�llll,llllllul n���lllllllllll�l.l!!II!!II!IIIIIIIIIIIIJulmr�lllllll ��u�lllllu�� I�IYIII IIIIIIIIIIIIIIIIIIIIJ�rlllllllllllllllllll II 111111 IIIIIIIIYIulllllullllllu�ll!Iluullllll fan-ners.com Policy No. 60559-16-27 Questions? Manage youraccount: Call your agent Nicole Lerno Insurance Go to www.farmers.com to access Agency Inc at(559)999.9005 or email your account anytime! nlerno@farmersagent.com yetis 1stEdition 4.15 Page 2of2 Oct 31 2017 12,42 HP Fax page 2 Eviden'ce of I nsu ran ce/Uen holder Interest I o 1, 1 lo Ill OP,i��111114 Ill 11,11"Wil I I I I I I ill 1111114 13!1; 111, 11,111,4l,11 1 j I I I ii I'llb,IIIIP� ll 111611,11 OP'll1il 14011 Ill 11, 1114 14111,11 fill Ill 1110�i 1 111 INO!I I WO 1111111� A 111,I I I I Ill 1111 All 11,1111111;dilill!JA I I:j I I 1 1,I11! 111 11 1 will,11 11:1. PoNcyNumber. 18300-50-40 Underwritten By. Mid-Century Insurance Company policyEdiff= Ist 6301 Owensmouth Ave. fective: S/17/2008 12:01 AM Woodland Hills,CA 91367 Expiration: Continuous until cancelled YourAgent: Nicole M Lemo Expiration Time. 12:01 AM 7636 N Ingram Ave Ste 102 Insured: GaryBufkin Fresno,CA 93711-6200 1374 N Linden Ave (559)999-9005 Fresno,CA 93728-2320 FAX-(559)921-5200 n lerno@farmersagent.com Vehicle Information Year Make Model VIN 20-03 Isuzu Rodeo 4D 04 4S2DMSSW234304721 Coverages Coverage Type UmItlDeductible Coverage Type UmWeductfbte Bodily Injury Liability $250,000 each person Collision $1,000 Deductible .........----................... ...... ac.cid.enl: Additional Equipment ..... $1,000 Property Damage 'L-ia,b'-il'ity.-* $100,000 each accident Uninsured Motorist Property W"ii; User jmito666bi'it-y' *--*-**** 'P' is"sv-e-,' '- 1Ful! Ii Gse Ir Damage With Collision Covered -1--l-............ ........ ...........1--................ ....dicai Coverage .........**--0,f,Liability,, ,I,ny?KE(�icy� Towing and Road Service Covered Not Covered Other ...... ............. .......................Co ver.ed ,G-Wl�'s'u*'r"e*'dM**'o**t"o-r,i*'s'*t-B-o-d-il'y-I I*'r'-y.....-...........$-2*'5'-0**,'l a-c**h'*-p"ll,a n $500,000 each accident Comprehensive $1,000 Deductible itlenholders andAdditional Interests Additional Interest Loan Number City ofElSegundo NotApplicable 350 Main St Ei Sgndo,CA90245-3813 This evidence Is subject to all of the terms,conditions and limitations set forth in the policy and endorsements attached to it.It is furnished as a matter of information only and does not change,modify or extend the policy In anyway.It supersedes all previously issued certificates. 1111 onmommIlIllilililliji I,Ill,1111111111 JjUla 1,1:111,,,,111110 I'l,'110 Ill 11"I1111111111 I Ili 11111111111111111101 111,111111411111401 Ill 11111111 Will 41111 1111111111 ;Ili I d"1111,11111111iIIIIJI11111111111 Ili 111 III I'll JAIII, iiiiiiii ii,riii 11111111 farmers.com 25.8976 9-13 Pana 1^f,> Oct 31 2017 12:42 HP Fax page 3 Evidence of Insurance/Lienhoider Interest(continued) IW I IIIlIIII IWMI II I I I I I I I. u � t o in I. I I �.������ I �u,ln IIII I n.W L... a 61 I I tll lul.�allll 11111110114111,111� 'JIOL,I ,I�Idd��.6llpllluyl4.el u�Iluulwl,udWllouI JIIIYlY14W+I6W�I�IWIWWuVWWIooIVW�uIIIIbIIu�IJIlwullllldyllmlllmlluylllllllW�ulllllllu166yIVnIaI,IV„„�I41,111�...,yY,0161VIIu,llyullul.y 11 llwynuarLiill d,�l��N�„IIIIIII,..�Wwuuum��„IWI dIuJII,III IddI�lAly�l��IJIYIY WuppouuulJlu .r lul�ild�l�,�������„�i lli� InBlu Iunll I I III IIIIIIVWI IIy11 Ilh �� .WPI{ I � Loss payable provisions (Applicable only if lienholder Is named,and no other Automobile loss payable endorsement Is attached to the policy) It is agreed that any payment for foss or damage to the vehicle The lienholder shall do whatever is necessary to secure such described In this podicyshall be made on the following basis, rights,No subrogation shall impair the right of the lienholder to 1. At our option,loss or damage shall be paid as interest may recover the full amount of its claim. appear to the policyholder and the lienholder shown In the We reserve the right to cancel this policy at any time as provided Declarations,or by repair of the damaged)vehicle, by its terms.In case of cancellation or lapse we will notify the Z. Any act or neglect of the policyholder or a person acting on lienholder at the address shown in the Declarations,we will give his behalf shall not void the coverage afforded to the the lienholder advance notice of not less than l'tl days from the lienholder, effective date of such cancellation or lapse as respects his 3, Change In title or ownership ofthe vehicle,or error in its interest.Mailing notice to the foss payee is sufficient to effect description shall not void coverage afforded to the cancellation. lienholder, The following applies as respects any loss adjusted with the The policy does not cover conversion,embezzlement or mortgagee interest only: secretion of the vehicle by the policyholder or anyone acting in 1. Any deductible applicable to Comprehensive Coverage shall his behalf whilein possession under a contract with the not exceed$250, lienholder. 2. Any deductible applicable to Collision Coverage shall not A payment may be made to the lienholder which we would not exceed$250. have been obligated to make except forthese terms.In such event,we are entitled to all the rights of the lienholder to the extent of such payment. i0/31/2017 Authorized Representative Date ��I Illll..ul I,i 6.m bull II. nol ad 6.I IIIIII.1,I'll 1111111 IIII014 lll,I lllmllIIIIyl4,11011 1111ll I lull II„ ulIuIII A1IuuIul1l•uIIIIIW111111111111,lulll l.m,n�uu ull0111111111"1111 114lllluuu IuWllllnllmnIll l Jwlln„lalluul,Ill uJI'll I'll llll,nlnl iliuII'll Ili IIIInIIIIIInNul,u,uIll Ill IIII u III IIL.Illldullmumuumy farmers,com 25-A976 9-13 Page 2 of 2 CITY OF EL SEGUNDO WORKERS' COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SUBJECTS AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($`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 dmploy any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Labor Code § 3700 1 must immediately comply with th 'provision, r agreemenLwjll automatically become void. Signature of Applicant Date �— L Print Name Agreement for. Gary Bufkin Computer Consulting-Agr.#2999K Dated: Reviewed by.,, r ,.,