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HomeMy WebLinkAboutAGMT - GovInvest (Pension/OPEB Liability Calculator)City of Seal Beach SaaS Licensing Agreement Attention: City of Seal Beach Prepared by: Jasmine Nachtigall- Fournier, President March 8, 2017 Page 1 Actuarial Services and Technology Q Govl nvest Licensing Agreemem -gh. m wu, f--.1 U- City of Seal Beach Summary of Services and Implementation Contact: Victoria Beatley, Director of Finance 211 8th St. Seal Beach, CA 90740 (562) 431 -2527 Ext 1311 vbeatley@sealbeachca.gov Services: Page 2 Use of the Standard Pension and OPEB Modules of the Total Liability Calculator with GASB 45 & 75 Reporting (the "Service(s) "). Service Fees: Pension Module - Annual Licensing Fee. $5,000 ($4,000 if Licensing Agreement signed by 4/8/17) OPEB Module - Annual Licensing Fee: $2,750 ($2,200 if Licensing Agreement signed by 4/8/17) GASB 45 Reports: Included with OPEB Module Annual Licensing Fee GASB 75 Reports: $550 per Report (Beginning FY17 -18) Annual fee will increase by the greater of the US CPI or 3% each consecutive year, and payable in advance subject to the terms of Section 4 herein. Initial term: Three years from Effective Date. Implementation Services: Company will use commercially reasonable efforts to provide Customer the services described in accordance with the terms herein, and Customer shall pay Company the Implementation Fee in accordance with the terms herein. Implementation Fee (One- Timc): Pension Module - Onboarding Fee: $1,500. OPEB Module - Onboarding Fee: $2,500. SERVICE AGREEMENT This SaaS Services Agreement ( "Agreement ") is entered into on this day of MAj-7W , 2017 (the "Effective Date ") between Govinvest, Inc. ( "Company "), and the Customer listed above ( "Customer "). This Agreement includes and incorporates the above Order Form, as well as the attached Terms and Conditions and contains, among other things, warranty disclaimers, liability limitations and use limitations. There shall be no force or effect to any different terms of any related purchase order or similar form even if signed by the parties after the date hereof. Govluvest Inc. Nam ,d'.1 Jasmine Nachtigall- Fournier Title: President Date: 3.30.2017 Actuarial Services and Technology COViC?VBSi Licensing Agreement Ivighu to you, financial lulme City of Seal Beach Page 3 TERMS AND CONDITIONS 1. SAAS SERVICES AND SUPPORT 1.1 Subject to the terns of this Agreement, Company will use commercially reasonable efforts to provide Customer the Services in accordance with the Service Level Terms attached hereto as Exhibit A. As part of the registration process, Customer will identify an administrative user name and password for Customer's Company account. Company reserves the right to refuse registration of, or cancel passwords it deems inappropriate. 1.2 Subject to the terms hereof, Company will provide Customer with reasonable technical support services in accordance with the terms set forth in Exhibit B. 2. RESTRICTIONS AND RESPONSIBILITIES 2.1 Customer will not, directly or indirectly: reverse engineer, decompile, disassemble or otherwise attempt to discover the source code, object code or underlying structure, ideas, know -how or algorithms relevant to the Services or any software, documentation or data related to the Services ( "Software "); modify, translate, or create derivative works based on the Services or any Software (except to the extent expressly permitted by Company or authorized within the Services); use the Services or any Software for timesharing or service bureau purposes or otherwise for the benefit of a third; or remove any proprietary notices or labels. 2.2 Further, Customer may not remove or export from the United States or allow the export or rc- export of the Services, Software or anything related thereto, or any direct product thereof in violation of any restrictions, laws or regulations of the United States Department of Commerce, the United States Department of Treasury Office of Foreign Assets Control, or any other United States or foreign agency or authority. As defined in FAR section 2.101, the Software and documentation are "commercial items" and according to DEAR section 252.22707014(a)(1) and (5) are deemed to be "commercial computer software" and "commercial computer software documentation." Consistent with DEAR section 227.7202 and FAR section 12.212, any use modification, reproduction, release, performance, display, or disclosure of such commercial software or commercial software documentation by the U.S. Government will be governed solely by the terms of this Agreement and will be prohibited except to the extent expressly permitted by the terms of this Agreement. 2.3 Customer represents, covenants, and warrants that Customer will use the Services only in compliance with Company's standard published policies then in effect (the "Policy ") and all applicable laws and regulations. [Customer hereby agrees to indemnify and hold harmless Company against any damages, losses, liabilities, settlements and expenses (including without limitation costs and attorneys' fees) in connection with any claim or action that arises from an alleged violation of the foregoing or otherwise from Customer's use of Services. Although Company has no obligation to monitor Customer's use of the Services, Company may do so and may prohibit any use of the Services it believes may be (or alleged to be) in violation of the foregoing. 2.4 Customer shall be responsible for obtaining and maintaining any equipment and ancillary services needed to connect to, access or otherwise use the Services, including, without limitation, modems, hardware, servers, software, operating systems, networking, web servers and the like (collectively, "Equipment "). Customer shall also be responsible for maintaining the security of the Equipment, Customer account, passwords (including but not limited to administrative and user passwords) and files, and for all uses of Customer account or the Equipment with or without Customer's knowledge or consent. Actuarial Services and Technology /^ Licensing Agreement GovI nves } l ­ i,h,. m rw, r�,,.,ci,i luw,a City of Seal Beach Page 4 3. CONFIDENTIALITY; PROPRIETARY RIGHTS 3.1 Each party (the "Receiving Party") understands that the other party (the "Disclosing Party") has disclosed or may disclose business, technical or financial information relating to the Disclosing Party's business (hereinafter referred to as "Proprietary information" of the Disclosing Party). Proprietary Information of Company includes non- public information regarding features, functionality and performance of the Service. Proprietary Information of Customer includes non- public data provided by Customer to Company to enable the provision of the Services ( "Customer Data "). The Receiving Party agrees: (i) to take reasonable precautions to protect such Proprietary Information, and (ii) not to use (except in performance of the Services or as otherwise permitted herein) or divulge to any third person any such Proprietary Information. The Disclosing Party agrees that the foregoing shall not apply with respect to any information after five (5) years following the disclosure thereof or any information that the Receiving Party can document (a) is or becomes generally available to the public, or (b) was in its possession or known by it prior to receipt from the Disclosing Party, or (c) was rightfully disclosed to it without restriction by a third party, or (d) was independently developed without use of any Proprietary Information of the Disclosing Party or (e) is required to be disclosed by law. 3.2 Company shall own and retain all right, title and interest in and to (a) the Services and Software, all improvements, enhancements or modifications thereto, (b) any software, applications, inventions or other technology developed in connection with Implementation Services or support, and (c) all intellectual property rights related to any of the foregoing. 3.3 Notwithstanding anything to the contrary, Company shall have the right collect and analyze data and other information relating to the provision, use and performance of various aspects of the Services and related systems and technologies (including, without limitation, information concerning Customer Data and data derived therefrom), and Company will be free (during and after the term hereof) to (i) use such information and data to improve and enhance the Services and for other development, diagnostic and corrective purposes in connection with the Services and other Company offerings, and (ii) disclose such data solely in aggregate or other de- identified form in connection with its business. No rights or licenses are granted except as expressly set forth herein. 4. PAYMENT OF FEES 4.1 Customer will pay Company the then applicable fees described in the Order Form for the Services and Implementation Services in accordance with the terms therein (the "Fees"), If Customer's use of the Services exceeds the Service Capacity set forth on the Order Form or otherwise requires the payment of additional fees (per the terms of this Agreement), Customer shall be billed for such usage and Customer agrees to pay the additional fees in the manner provided herein. Company reserves the right to change the Fees or applicable charges and to institute new charges and Fees at the end of the Initial Service Term or then ®current renewal term, upon thirty (30) days prior notice to Customer (which may be sent by email). If Customer believes that Company has billed Customer incorrectly, Customer must contact Company no later than 60 days after the closing date on the first billing statement in which the error or problem appeared, in order to receive an adjustment or credit.. Inquiries should be directed to Company's customer support department. 4.2 Company may choose to bill through an invoice, in which case, full payment for invoices issued in any given month must be received by Company thirty (30) days after the mailing date of the invoice. Unpaid amounts arc subject to a finance charge of 1.5% per month on any outstanding balance, or the maximum permitted by law, whichever is lower, plus all expenses of collection and may result in immediate termination of Service. Customer shall be responsible for all taxes associated with Services other than U.S. taxes based on Company's net income. Actuarial Services and Technology �^ Licensing Agreement Govi vest Imi9M1a m yom 4nenciel fmure City of Seal Beach Page 5 5. TERM AND TERMINATION 5.1 Subject to earlier termination as provided below, this Agreement is for the Initial Service Term as specified in the Order Form, and shall be automatically renewed for additional periods of the same duration as the Initial Service Term (collectively, the "Tenn "), unless either party requests termination at least thirty (30) days prior to the end of the then - current term. 5.2 In addition to any other remedies it may have, either party may also terminate this Agreement upon thirty (30) days' notice (or without notice in the case of nonpayment), if the other party materially breaches any of the terms or conditions of this Agreement. Customer will pay in full for the Services up to and including the last day on which the Services are provided. All sections of this Agreement which by their nature should survive termination will survive termination, including, without limitation, accrued rights to payment, confidentiality obligations, warranty disclaimers, and limitations of liability. 6. WARRANTY AND DISCLAIMER Company shall use reasonable efforts consistent with prevailing industry standards to maintain the Services in a manner which minimizes errors and interruptions in the Services and shall perform the Implementation Services in a professional and workmanlike manner as expressed in Exhibit C. Services may be temporarily unavailable for scheduled maintenance or for unscheduled emergency maintenance, either by Company or by third -party providers, or because of other causes beyond Company's reasonable control, but Company shall use reasonable efforts to provide advance notice in writing or by c -mail of any scheduled service disruption. However, Company does not warrant that the Services will be uninterrupted or error free; nor does it make any warranty as to the results that may be obtained from use of the Services. EXCEPT AS EXPRESSLY SET FORTH IN THIS SECTION, THE SERVICES AND IMPLEMENTATION SERVICES ARE PROVIDED "AS IS" AND COMPANY DISCLAIMS ALL WARRANTIES, EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE AND NON - INFRINGEMENT. INDEMNITY Company shall hold Customer harmless from liability to third parties resulting from infringement by the Service of any United States patent, any copyright, misappropriation of any trade secret, provided Company is promptly notified of any and all threats, claims and proceedings related thereto and given reasonable assistance and the opportunity to assume sole control over defense and settlement; Company will not be responsible for any settlement it does not approve in writing. The foregoing obligations do not apply with respect to portions, components of the Service (i) not supplied by Company, (ii) made in whole, in part in accordance with Customer specifications, (iii) that are modified after delivery by Company, (iv) combined with other products, processes, materials where the alleged infringement relates to such combination, (v) where Customer continues allegedly infringing activity after being notified thereof after being informed of modifications that would have avoided the alleged infringement, (vi) where Customer's use of the Service is not strictly in accordance with this Agreement. If, due to a claim of infringement, the Services are held by a court of competent jurisdiction to be, are believed by Company to be infringing, Company may, at its option and expense (a) replace, modify the Service to be non - infringing provided that such modification, replacement contains substantially similar features and functionality, (b) obtain for Customer a license to continue using the Service, (c) if neither of the foregoing is commercially practicable, terminate this Agreement and Customer's rights hereunder and provide Customer a refund of any prepaid, unused fees for the Service. Actuarial Services and Technology Licensing Agreement, Gov(nvest 'I"II IrtdghB m ro�� finmdal luwre City of Seal Beach Page 6 8. LIMITATION OF LIABILITY NOTWITHSTANDING ANYTHING TO THE CONTRARY, EXCEPT FOR BODILY INJURY OF A PERSON, COMPANY AND ITS SUPPLIERS (INCLUDING BUT NOT LIMITED TO ALL EQUIPMENT AND TECHNOLOGY SUPPLIERS), OFFICERS, AFFILIATES, REPRESENTATIVES, CONTRACTORS AND EMPLOYEES SHALL NOT BE RESPONSIBLE OR LIABLE WITH RESPECT TO ANY SUBJECT MATTER OF THIS AGREEMENT OR TERMS AND CONDITIONS RELATED THERETO UNDER ANY CONTRACT, NEGLIGENCE, STRICT LIABILITY OR OTHER THEORY: (A) FOR ERROR OR INTERRUPTION OF USE OR FOR LOSS OR INACCURACY OR CORRUPTION OF DATA OR COST OF PROCUREMENT OF SUBSTITUTE GOODS, SERVICES OR TECHNOLOGY OR LOSS OF BUSINESS; (B) FOR ANY INDIRECT, EXEMPLARY, INCIDENTAL, SPECIAL OR CONSEQUENTIAL DAMAGES; (C) FOR ANY MATTER BEYOND COMPANY'S REASONABLE CONTROL. 9. MISCELLANEOUS If any provision of this Agreement is found to be unenforceable or invalid, that provision will be limited or eliminated to the minimum extent necessary so that this Agreement will otherwise remain in full force and effect and enforceable. This Agreement is not assignable, transferable or sublicensable by Customer except with Company's prior written consent. Company may transfer and assign any of its rights and obligations under this Agreement without consent. This Agreement is the complete and exclusive statement of the mutual understanding of the parties and supersedes and cancels all previous written and oral agreements, communications and other understandings relating to the subject matter of this Agreement, and that all waivers and modifications must be in a writing signed by both parties, except as otherwise provided herein. No agency, partnership, joint venture, or employment is created as a result of this Agreement and Customer does not have any authority of any kind to bind Company in any respect whatsoever. In any action or proceeding to enforce rights under this Agreement, the prevailing party will be entitled to recover costs and attorneys' fees. All notices under this Agreement will be in writing and wilt be deemed to have been duly given when received, if personally delivered; when receipt is electronically confirmed, if transmitted by facsimile or e -mail; the day after it is sent, if sent for next day delivery by recognized overnight delivery service; and upon receipt, if sent by certified or registered mail, return receipt requested. This Agreement shall be governed by the laws of the State of California without regard to its conflict of laws provisions. The parties shall work together in good faith to issue at least one mutually agreed upon press release within 90 days of the Effective Date, and Customer otherwise agrees to reasonably cooperate with Company to serve as a reference account upon request. Actuarial Services and Technology /\ GOVIC1U�St Licensing Agreement �✓_ Imf 1 1 1-21 LUCre City of Seat Beach EXHtBIT A Service Level Ternts Page 7 The Services shall be available 99.9 %, measured monthly, excluding holidays and weekends and scheduled maintenance. If Customer requests maintenance during these hours, any uptime or downtime calculation will exclude periods affected by such maintenance. Further, any downtime resulting from outages of third party connections or utilities or other reasons beyond Company's control will also be excluded from any such calculation. Customer's sole and exclusive remedy, and Company's entire liability, in connection with Service availability shall be that for each period of downtime lasting longer than 12 hours, Company will credit Customer 1% of Service fees for each period of 30 or more consecutive minutes of downtime; provided that no more than one such credit will accrue per day. Downtime shall begin to accrue as soon as Customer (with notice to Company) recognizes that downtime is taking place, and continues until the availability of the Services is restored. In order to receive downtime credit, Customer must notify Company in writing within 12 hours from the time of downtime, and failure to provide such notice will forfeit the right to receive downtime credit. Such credits may not be redeemed for cash and shall not be cumulative beyond a total of credits for one (I ) week of Service Fees in any one (1) calendar month in any event. Company will only apply a credit to the month in which the incident occurred. Company's blocking of data communications or other Service in accordance with its policies shall not be deemed to be a failure of Company to provide adequate service levels under this Agreement. Actuarial Services and Technology Gov�nvest Licensing Agreement i Imi'h"'o yourfnandel Nw'. 4 City of Seal Beach EXHIBIT B Support Terms Company will provide Technical Support to Customer via both telephone and electronic mail on weekdays during the hours of 9:00 am through 5:00 pm Pacific time, with the exclusion of Federal Holidays ( "Support Hours "). Page 8 Customer may initiate a help desk ticket during Support Hours by calling 213 -534 -6898 or any time by emailing support @govinvest.com. Company will use commercially reasonable efforts to respond to all Helpdesk tickets within one (I ) business day. Actuarial Services and Technology Govinvest Licensing Agreement msghu m ro� Rnadal lumra City of Seal Beach EXHIBIT C Disclaimer of Analysis Page 9 Company will provide the software with financially sound projections and analysis, but does not yet guarantee compliance with actuarial standards for funding and accounting purposes including GASB 68, 27, 45 or 75. Actuarial Services and Technology �. Licensing Agreement • ' GOVinvest '�� (-0. fwv,e From: (rain AStewle To: Vikki Beadev Cc: I xIie Encson Subject RE: Emailing - CityofSealBeach3141 Final 2015Report.pdf Date: Thursday, March 09, 2017 5:57:27 PM Attachments: imaoe002.ono If you're satisfied with the business points, I have no further comment on the agreement. From: Vikki Beatley [ mailto :vbeatley @sealbeachca.gov) Sent: Thursday, March 09, 2017 1:17 PM To: Craig A. Steele Cc: Leslie Ericson Subject: FW: Emailing - CityofSea lBeach3141Final2015Report.pdf Good afternoon Craig. Taking a look at Govinvest again. I intend to sign the agreement once reviewed, thank you. Vikki Victoria L. Beatley Director of Finance /City Treasurer City of Seal Beach - 211 Eighth Street, Seal Beach, CA 90740 (562) 431 -2527 Ext.1311 If we embrace purpose we gain power For Information about Seal Beach, release see our city website: ht1{lalwwwsealbgachca . oov NOTICE. This communication may contain privileged or other confidential information. If you are not the intended recipient of this communication. or an employee or agent responsible for delivering this communication to the intended recipient, please advise the sender by reply email and immediately delete the message and any attachments without copying or disclosing the contents. Thank you. From: Jasmine Nachtigall- Fournier [mailtoiiasmin @goviovesL.com] Sent: Wednesday, March 08, 2017 3:18 PM To: Vikki Beatley Cc: Stephen Acker Subject: Re: Emailing - CityofSealBeach3141Final2015Report.pdf Fli Vikki, Thank you very much for sending this over, and for taking the time to meet yesterday! As promised, please see attached for the latest version of our Licensing Agreement with your City Attorney's changes and the updates we discussed yesterday (updated Pension Module pricing + OPEB Module & GASB 45/75 Reports). Please feel free to put me in touch with your City Attorney - I'm happy to work with them directly to make any further changes to the agreement. Iit4 it, big. I *N SCHEDULE OF COVERED AUTOS YOU OWN AU -DEC G (09/07) INSURED Page 3 DESCRIPTION PURCHASED TERRITORY Covered Auto No. Year, Model, Trade Name, Body Type Serial Number (S) Vehicle Identification Number (VIN) Original Cost New Actual Cost & NEW (N) USED (U) Town & State Where The Covered Auto Will Be Principally Garaged CA. 2009, TOYOTA COROLLA, 1NXe040E69Z029903 58,900 ACV iris Angeles CA, 054 CLASSIFICATION _- Covered Auto No. Radius Of Operation Business Use s -Semce r= retail C= commercial Size GVW, GCW Or Vehicle Seating Capacity Age Group Primary Rating Factor Secondary Rating Factor Code EXCEPT For Towing, All Physical Damage Loss Is Payable To You And The Loss Payee Named Below As Interests May Appear At the Time Of The Loss. Lab. Phy. Dam. CAI 50 8 i.0 i.0 /1.0 739100 Covered COVERAGES - PREM IUMS, LIMITS AND DEDUCTIBLES (Absence of a deductible or limit entry in any column below means that the limit or deductible entry in the correspondin ITEM TWO column applies instead. Auto No. LIABILITY PERSONAL INJURY PROTECTION ADDED P.LP PROPERTY PROTECTION (Michigan Only) Limit Premium Limit Stated In Each P.I.P. Endt. Minus Deductible Shown Below Premium Premium For Limit Stated In Each Added PAP. Endt. Limit Stated In P.P.I. Endt. Minus Deductible Shown Below Premium CA! 1,000,000 S 2,248 Total Premium 5f tl i n y5 9ay�EaElil - � 5 r -� .no. <M S 2,248 "u'il h. Yr„arRr�M `f� An5aiitr�az xLz'. .. d k u:5 €ry a .r� AU -DEC G (09/07) INSURED Page 3 ITEM THREE SCHEDULE OF COVERED AUTOS YOU OWN (Cont'd) Covered Auto No. COVERAGES- PREMIUMS, LIMITS AND DEDUCTIBLES (Absence of a deductible or limit entry in any column below means that the limit or deductible entry in the corresponding ITEM TWO column a ies instead. AUTO MEDICAL PAYMENTS MEDICAL EXPENSE AND INCOME LOSS BENEFITS (Virginia Only) Limit Premium Limit Stated; Each Medical Expense and Premium Income Lass Endorsement For Each Person CA1 Total Premm u ' i = - 1 _ f� i a i-i . [ sfNRU t x �' b -c uy�;a Covered Auto No. COVERAGES- PREMIUMS, LIMITS AND DEDUCTIBLES (Absence of a deductible or limit entry in any column below means that the limit or deductible entry in the corresponding ITEM TWO column a lies instead. COMPREHENSIVE/ SPECIFIEDCAUSES TOWING &LABOR COLLISION OF LOSS Limit Stated In ITEM TWO Premium Limit Stated In ITEM TWO Premium Limit Per Disablement Premium Minus Minus Deductible Deductible Shown Shown Below Below CA! $500 /$500 $ 410 Total Premium ' �i k of i��9 F1 d? $ 4101 erT� napp e �t iS 3 �ii y Tk f u) tt�fh AU -DEC G (09/07) v MAMA Page 4 INSURED DIVIDER PAGE Producer No: 67504 SAN: 42504620000000 Pol Eff Dt: 04 -17 -2016 Office: 99 Date Printed: 02 -29 -2016 Time Printed: 16:18:14 Trans Eff Dt: 04 -17 -2016 Insured Name: GOV INVEST, INC Policy No: 9100082601 Trans Seq No: 001 Trans Type: Renewal Issue Oper Init: A171721 Company Abbr: GK Release Version: 15.26 User - Selected Sets Copies Printer INSURED 01 RWPRINT8- HP LJ 9050 COMPANY 01 Don't print CERTIFIED COPY 01 Don't print CERTIFICATES 01 No forms to include with this set INSURED Policy Number: 9100082601 01 GOV INVEST, INC 900 S FIGUEROA ST APT 505 LOS ANGELES CA 90015 -3918 ATTACHED ARE DOCUMENTS FOR THE FOLLOWING NAMED INSURED: GOV INVEST, INC 900 S FIGUEROA ST APT 505 LOS ANGELES CA 90015 -3918 uz -6 h—lb INSURED Business Auto Policy Amendment Government Employees Insurance Company GENERAL LIABILITY PUNITIVE Policy Number: 9100082601 01 DAMAGE EXCLUSION DUTY TO Effective Date: 04 -17 -2016 DEFEND THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies the insurance provided under all coverage forms. The insuring agreement is amended to provide that this insurance does not apply to any sums awarded as punitive damages. For the purposes of this Endorsement, punitive damages include, but are not limited to, the following punitive damages, exemplary damages, treble damages, statutory damages, and any other damages which are awarded to punish or deter a wrongdoer, deter others from similar conduct, or any other similar type of damages. Subject to all other terms, conditions and exclusions of the policy, the Company has the right to defend any suit against the insured which seeks both punitive damages and damages to which this insurance applies. However, the Company has no duty to defend any suit seeking only punitive damages or where the remaining allegations of a complaint seek only punitive damages. The Company shall have the right to settle that part or parts of a suit seeking damages other than punitive damages. In the event of a conflict of interest between the insured and the Company due to allegations which might result in an award of punitive damages against the insured or due to other allegations not covered by this insurance, the Company shall not be obligated to retain separate counsel to represent the interests of the insured with respect to defense of non - covered allegations, but the insured shall have the right to retain separate counsel at the insured's expense to serve as co- counsel. The Company shall not be required to relinquish control of the defense to such cc counsel so long as covered allegations remain in the suit. All other terms, conditions and agreements of the policy shall remain unchanged. This amendment is affirmed. wj,.4� W.C.E. Robinson Secretary 85218 (OM7) EM11aaa William E. Roberts President POLICY NUMBER: 9100082601 01 COMMERCIAL AUTO BA 20 48 0810 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM Wth respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provi- sion of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: Countersigned By: 04 -17 -2016 Named Insured: GOV INVEST, INC Authorized Representative) SCHEDULE Name of Person(s) or Organization(s): THE MOLLER COMPANY 3838 CARSON ST, STE 100 TORRANCE, CA 90503 -6703 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an 'insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. BA 20 48 0810 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 ❑ with its permission. INSURED POLICY NUMBER: 91000 82 601 01 COMMERCIAL AUTO CA 2154 09 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA UNINSURED MOTORISTS COVERAGE - BODILY INJURY For a covered "auto" licensed or principally garaged in or "garage operations" conducted in California, this en- dorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Endorsement Effective Date: SCHEDULE Limit Of Insurance: $ 1, 000, 000 Each "Accident' Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Coverage 1. We will pay all sums the "insured" is legally entitled to recover as compensatory damages from the owner or driver of an "uninsured mo- tor vehicle ". The damages must result from "bodily injury" sustained by the "insured" caused by an "accident ". The owner's or driver's liability for these damages must result from the ownership, maintenance or use of the "uninsured motor vehicle ". 2 We will pay only after the limits of liability under any liability bonds or policies have been ex- hausted by payment of judgments or settle- ments. 3. Any judgment for damages arising out of a "suit" brought without our written consent is not binding on us. CA 21 54 09 09 B. Who Is An Insured If the Named Insured is designated in the Declara- tions as: 1. An individual, then the following are 'Insureds": a. The Named Insured and any 'family mem- bers". b. Anyone else "occupying" a covered "auto" or a temporary substitute for a covered "auto ". The covered "auto" must be out of service because of its breakdown, repair, servicing, "loss "or destruction. c. Anyone for damages he or she is entitled to recover because of "bodily injury" sustained by another "insured". © Insurance Services Office, Inc., 2009 INSURED Page 1 of 4 ❑ 2 A partnership, limited liability company, corpo- 5. "Bodily injury' sustained by an individual ration or any other form of organization, then Named Insured or any 'family member" while the following are insureds ": "occupying" any vehicle leased by that Named a. Anyone "occupying" a covered "auto" or a Insured or any 'family member" under a written temporary substitute for a covered "auto ". contract for a period of six months or more that The covered "auto" must be out of service is not a covered "auto ". because of its breakdown, repair, servicing, 6. Anyone using a vehicle without a reasonable "loss" or destruction. belief that the person is entitled to do so. b. Anyone for damages he or she is entitled to 7. "Bodily injury' sustained by an "insured" while recover because of "bodily injury" sustained "occupying" any "auto" that is rented or leased by another "insured". to that 'insured" for use as a public or livery C. Exclusions conveyance. However, this exclusion does not This insurance does not apply to any of the follow- apply if the 'insured" is in the business of pro - viding public or livery conveyance. ing: 8. "Bodily injury" arising directly or indirectly out 1. Punitive or exemplary damages. of: 2 Any claim settled without our consent. How- a. War, including undeclared or civil war; ever, this exclusion does not apply to a settle- settle- ment made with the insurer of a vehicle de- b. Warlike action b a military force, including y y g scribed in Paragraph b. of the definition of action in hindering or defending against an "uninsured motor vehicle ". actual or expected attack, by any govern- 3. The direct or indirect benefit of any insurer or ment, sovereign or other authority using military personnel or other agents; or self- insurer under any workers' compensation, disability benefits or similar law or to the direct c. Insurrection, rebellion, revolution, usurped benefit of the United States, a state or its politi- power, or action taken by governmental au- ral subdivisions. thority in hindering or defending against 4. "Bodily injury" sustained by: any of these. D. Limn Of Insurance a. An individual Named Insured while "occupy- ing" or when struck by any vehicle owned 1. Regardless of the number of covered "autos ", by that Named Insured that is not a covered "insureds ", premiums paid, claims made or ve- "auto" for Uninsured Motorists Coverage hicles involved in the "accident ", the most we under this coverage form; will pay for all damages resulting from any one "accident" is the Limit of Insurance for Unin- b. Any 'family member" while "occupying" or sured Motorists Coverage shown in the Sched- when struck by any vehicle owned by that ule or Declarations. 'family member" that is not a covered "auto" for Uninsured Motorists Coverage under 2. For a vehicle described in Paragraph b. of the this coverage form; or definition of "uninsured motor vehicle ", our Limit of Insurance shall be reduced by all sums c. Any 'family member" while "occupying" or paid because of "bodily injury' by or for anyone when struck by any vehicle owned by the who is legally responsible, including all sums Named Insured that is insured for Unin- paid or payable under this policy's Liability sured Motorists Coverage on a primary ba- Coverage. sis under any other coverage form or pol- icy. 3. No one will be entitled to receive duplicate However, Exclusion 4. shall not apply to "bodily payments for the same elements of "loss" under this coverage and any Liability Coverage form injury" sustained by an individual Named In- 'family or Medical Payments Coverage endorsement sured or member" when struck by a ve- attached to this Coverage Part. hicle owned by that "insured" and operated or caused to be operated by a person without that We will not make a duplicate payment under "insured's" consent in connection with criminal this coverage for any element of 'toss' for activity that has been documented in a police which payment has been made by or for any - report and to which that "insured" is not a party one who is legally responsible. to. Page 2 of 4 © Insurance Services Office, Inc., 2009 CA 21 54 09 09 ❑ INSURED M will not pay for any element of 'loss" if a person is entitled to receive payment for the same element of 'loss" under any workers' compensation, disability benefits or similar law. E. Changes In Conditions The Conditions are changed for California Unin- sured Motorists Coverage — Bodily Injury as fol- lows: 1. Duties In The Event Of Accident, Claim, Suit Or Loss is changed by adding the following: a. Promptly notify the police if a hit - and -run driver is involved; and b. Send us copies of the legal papers if a "suit" is brought. In addition, a person seeking coverage under Paragraph b. of the defini- tion of "uninsured motor vehicle" must: (1) Provide us with a copy of the complaint by personal service or certified mail if the "insured" brings an action against the owner or operator of such "uninsured motor vehicle'; (2) Within a reasonable time, make all plead- ings and depositions available for copy- ing by us or furnish us copies at our ex- pense; and (3) Provide us with proof that the limits of insurance under any applicable liability bonds or policies have been exhausted by payment of judgments or settlements. 2 Legal Action Against Us is replaced by the following: No legal action may be brought against us un- der this coverage form until there has been full compliance with all the terms of this coverage form and with respect to Paragraphs a., c. and d. of the definition of "uninsured motor vehicle" unless within two years from the date of the "accident ": a. Agreement as to the amount due under this insurance has been concluded; b. The "insured" has formally instituted arbitra- tion proceedings against us. In the event that the "insured" decides to arbitrate, the "insured" must formally begin arbitration proceedings by notifying us in writing, sent by certified mail, return receipt requested; or c. "Suit" for "bodily injury' has been filed against the uninsured motorist in a court of competent jurisdiction. Written notice of the "suit" must be given to us within a reasonable time after the 'in- sured" knew, or should have known, that the other motorist is uninsured. In no event will such notice be required before two years from the date of the accident. Failure of the 'insured" or his or her representative to give us such notice of the "suit" will re- lieve us of our obligations under this cover- age form only if the failure to give notice prejudices our rights. 3. Transfer Of Rights Of Recovery Against Others To Us is replaced by the following: a. With respect to Paragraphs a., c. and d. of the definition of "uninsured motor vehicle', if we make any payment, we are entitled to re- cover what we paid from other parties. Any person to or for whom we make payment must transfer to us his or her rights of re- covery against any other party. This person must do everything necessary to secure these rights and must do nothing that would jeopardize them. b. With respect to Paragraph b. of the defini- tion of "uninsured motor vehicle', if we make any payment and the "insured" recov- ers from another party, the "insured" shall hold the proceeds in trust for us and pay us back the amount we have paid. 4. Other Insurance in the Business Auto and Garage Coverage Forms and Other Insurance — Primary And Excess Insurance Provisions in the Truckers and Motor Carrier Coverage Forms are replaced by the following: If there is other applicable insurance available under one or more policies or provisions of coverage: a. The maximum recovery under all coverage forms or policies combined may equal but not exceed the highest applicable limit for any one vehicle under any coverage form or policy providing coverage on either a pri- mary or excess basis. b. Any insurance we provide with respect to a vehicle the Named Insured does not own shall be excess over any other collectible uninsured motorists insurance providing coverage on a primary basis. CA 21 54 09 09 © Insurance Services Office, Inc., 2009 Page 3 of 4 ❑ IN RED c. If the coverage under this coverage form is 2. "Occupying" means in, upon, getting in, on, out provided: or off. (1) On a primary basis, we will pay only our 3. "Uninsured motor vehicle' means a land motor share of the 'loss" that must be paid un- vehicle or trailer: der insurance providing coverage on a a. For which no liability bond or policy at the primary basis. Our share is the propor- time of an "accident" provides at least the tion that our limit of liability bears to the amounts required by the applicable law total of all applicable limits of liability for where a covered "auto" is principally ga- coverage on a primary basis. raged; (2) On an excess basis, we will pay only our b. That is an underinsured motor vehicle. An share of the 'loss" that must be paid un- underinsured motor vehicle is a land motor der insurance providing coverage on an vehicle or 'trailer" for which the sum of all li- excess basis. Our share is the propor- ability bonds or policies at the time of an tion that our limit of liability bears to the "accident" provides at least the amounts re- total of all applicable limits of liability for quired by the applicable law where a cov- coverage on an excess basis. ered "auto" is principally garaged but that 5. The following Condition is added: sum is less than the Limit of Insurance for Arbitration this coverage; a. If we and an 'insured" disagree whether the c. For which an insuring or bonding company "insured" is legally entitled to recover dam- denies coverage or refuses to admit cover- ages from the owner or driver of an "unin- age except conditionally or with reservation sured motor vehicle" or do not agree as to or becomes insolvent; the amount of damages that are recoverable d. That is a hit-and-run vehicle and neither the by that "insured ", the disagreement will be driver nor owner can be identified. The ve- settled by arbitration. Such arbitration may hicle must make physical contact with an be initiated by a written demand for arbitra- 'insured ", a covered "auto" or a vehicle an tion made by either party. The arbitration 'insured" is "occupying'; or shall be conducted by a single neutral arbi- e. That is owned by an individual Named In- trator. However, disputes concerning cov- sured or 'family member" and operated or erage under this endorsement may not be caused to be operated by person without arbitrated. Each party will bear the ex- the owner's consent in connection with penses of the arbitrator equally. criminal activity that has been documented b. Unless both parties agree otherwise, arbi- in a police report. tration will take place in the county in which However, "uninsured motor vehicle" does not the "insured" lives. Local rules of law as to include any vehicle: arbitration procedures and evidence will apply. The decision of the arbitrator will be a. Owned or operated by a self- insurer under binding. any applicable motor vehicle law except a F. Additional Definitions self- insurer who is or becomes insolvent and cannot provide the amounts required The following are added to the Definitions section: by that motor vehicle law; 1. "Family member' means the individual Named b. Owned by the United States of America, Insured's spouse, whether or not a resident of Canada, a state or political subdivision of the individual Named Insured's household, and any of those governments or an agency of any other person related to such Named In- any of the foregoing; or sured by blood, adoption, marriage or regis- c. Designed or modified for use primarily off tered domestic partnership under California public roads while not on public roads. law, who is a resident of such Named Insured's household, including a ward or foster child. Page 4 of 4 © Insurance Services Office, Inc., 2009 INSURED CA 21 54 09 09 ❑ Government Employees Insurance Company Policy Number: 9100082601 01 GOVERNMENT EMPLOYEES INSURANCE COMPANY CALIFORNIA UNINSURED MOTORIST BODILY INJURY (UM /UIM) COVERAGE (INCLUDES UNDERINSURED MOTORIST COVERAGE) Please read this form carefully. It contains valuable information about coverages available to you. Please complete, sign and return this form if you have been instructed to do so or wish to make any changes to these coverages. California law requires insurers to offer Uninsured Motorist Bodily Injury (UM /UIM) coverage in limits equal to but not exceeding your Bodily Injury (BI) Liability limits. You may reject the coverage entirely or select UM /UIM limits less than your BI limits. WHAT WE RECOMMEND For your protection, we recommend that you do not reject Uninsured Motorist Bodily Injury coverage. This valuable protection covers you, household relatives and passengers in the insured automobile who are legally entitled to recover because of bodily injury or death caused by uninsured or hit - and -run motorists. It pays up to the first limit for any one person injured or killed and up to the second limit for two or more persons injured or killed, not to exceed the first limit for any one person. UNDERINSURED MOTORIST COVERAGE EXPLAINED (UIM) Underinsured motorist coverage pays the difference between your selected limits and the at fault driver's Bodily Injury limits based upon the value of the injury claim. For example: If your UM /UIM limits are $300,000, the at fault driver's Bodily Injury limit is $200,000, and the value of injury claim totals $250,000, we will pay $50,000 under your UM /UIM coverage. However, if you carry $100,000 UM /UIM coverage, there would be no difference between the two limits and no payment would be due even if the value of the injury claim exceeded that amount. The following information is required by the State of California: The California Insurance Code requires an insurer to provide Uninsured Motorist coverage in each bodily injury liability insurance policy it issues covering liability arising out of the ownership, maintenance, or use of a motor vehicle. Such section also permits the insurer and the applicant to delete such coverage completely or to delete such coverage when a motor vehicle is operated by a natural person or persons designated by name, or agree to provide such coverage in an amount less than that required by subdivision (m) of Section 11580.2 of the Insurance Code, but not less than the financial responsibility requirements. Uninsured Motorist coverage insures the insured, his heirs, or legal representatives for all sums within the limits established by law, which such person or persons are legally entitled to recover as damages for bodily injury, including any resulting sickness, disease, or death, to him from the owner or operator of an uninsured motor vehicle not owned or operated by the insured or a resident of the same household. An uninsured motor vehicle includes an underinsured motor vehicle as defined in Subdivision (p) of Section 11580.2 of the Insurance Code. Bodily Injury Liability Coverage: $1, 000, 000 Please indicate your selection below and sign, date and return this form to us immediately. Note that UM /UIM cannot exceed your BI limits. I select Bodily Injury Uninsured Motorists Coverage at limits equal to the limits of my Bodily Injury Liability Coverage I reject Bodily Injury Uninsured Motorists Coverage at limits equal to my Bodily Injury Liability Coverage and 1 select following lower limits. $100,000 $300,000 ❑ $500,000 $600,000 $750,000 $1,000,000 These limits are not available if any insured or driver has a motor carrier permit. I reject Bodily Injury Uninsured Motorists Coverage entirely. Signature Signature Print Name Print Name Date Date B316CACL(06 -10) policy Number: 9100082601 01 Page f oft INS ED UNINSURED MOTORIST PROPERTY DAMAGE COVERAGE AND COLLISION DEDUCTIBLE WAIVER WHAT THE LAW REQUIRES IF your policy includes Uninsured Motorist Bodily Injury (UM /UIM) coverage as described on the reverse side, we are required to offer you the following coverages. 1. COLLISION DEDUCTIBLE WAIVER. If any vehicle on your policy carries Collision coverage, you may select this coverage on that vehicle, which provides that the Collision deductible, if any, will be paid by us in the event of a collision between that vehicle insured by us and an at -fault uninsured motor vehicle. 2 UNINSURED MOTORIST PROPERTY DAMAGE (UMPD). For any vehicle on the policy that does not carry Collision coverage, you may select this coverage on that vehicle, which provides that we will pay you the actual cash value or $3,500, whichever is less, for loss or damage to that vehicle (except loss of use of that vehicle and personal property therein) caused by the owner or operator of an at -fault uninsured motor vehicle. WHEN WE WILL PAY We will waive the Collision deductible or pay under the UMPD only when the collision involves actual direct physical contact between your vehicle and the uninsured vehicle, and the owner or operator of the uninsured vehicle is identified, or the vehicle itself is identified by license plate number, and you report the accident to us within 10 business days. To collect the Collision deductible or payment under UMPD, the owner or operator of the uninsured motor vehicle must be legally liable to you for damage. The following information is required by the State of California: The California Insurance Code requires insurers to offer coverage for damage to the insured motor vehicle, to the extent that you are legally entitled to recover from the owner or operator of the uninsured motor vehicle, that either: (1) Pays the Collision deductible on the insured motor vehicle when you have purchased Collision coverage. (2) Pays for the damage to the insured motor vehicle when you have not purchased Collision coverage. Payment shall not include damage to personal property or loss of use of a motor vehicle and shall not exceed the smaller of any of the following: (A) The amount of the Collision deductible. (B) The actual cash value of the insured motor vehicle. (C) $3,500. You may reject such coverage completely or reject such coverage when an insured motor vehicle is operated by a natural person or persons designated by name. If you carry Uninsured Motorist Bodily Injury coverage and wish to make any changes to your policy please indicate your selections and sign, date and return this form to us. I want Collision Deductible Waiver on all vehicles on my policy with Collision coverage. I want Uninsured Motorist Property Damage on all vehicles on my policy without Collision coverage. I reject Collision Deductible Waiver on applicable vehicles. I reject Uninsured Motorist Property Damageon applicable vehicles. B316CACL(06 -10) Policy Number: 9100082601 01 Page 2of2 INSURED GEICO PRIVACY NOTICE GEICO Respects Your Privacy Protecting your privacy is very important to us. Policyholders like you have trusted us with their insurance needs for over 70 years, and we take our obligation to safeguard and secure your personal Information very seriously. We want you to understand how we protect your privacy and when we collect and use your Information. The Information We Collect Non - public personally identifiable Information ( "Information') is Information that identifies you and is not available to the general public. The following sections tell you more about how and when we collect your informa -tion. Information We Obtain From You During the quoting, application, or claims handling processes you may give us Information such as your: o name o address o phone number o email address o Social Security number o driver's license number o date of birth If you gave us your email address, GEICO may use it from time to time to notify you of such things as new services, special offers, or to confirm transactions. Information About Your Transactions We may collect Information about your transactions and experiences with us and others, such as your payment history, claims, coverage, and vehicles changes. Information From Third Parties We may receive Information about you from consumer reporting agencies, which provide us with motor vehicle reports and claim reports. If you commit to purchase a policy with GEICO, we will confirm your motor vehicle record and claims history. As permitted by law, we may also review your motor vehicle record. The Information We Disclose Information about our customers or former customers will only be disclosed as permitted or required by law. Information about you that has been collected is maintained in your policy and /or claims records. We use this Information to process and service your policy; to settle claims; with your consent; or as directed by you. We may also disclose it to persons or organizations as necessary to perform transactions you request or authorize. Information about our former customers and about individuals who have obtained quotes from us is safeguarded to the same extent as Information about our current policyholders. Following are some examples of how we may disclose Information: We must exchange Information about you with our agents, investigators, appraisers, attorneys, and other persons who are or will become involved in processing your application and servicing your policy or any claims you may make. When you are involved in a claim, policy Information is provided to adjusters and the businesses that will repair your vehicle. We may share Information with persons or organizations that we have determined need the Information to perform a business, professional, or insurance function for us. These include businesses that help us with administrative functions. If the law in your state permits, we may share Information with financial institutions with which we have a joint- marketing agreement. All of these entities are obligated to keep the Information that we provide to them confidential and to use the Information only for the purpose for which the Information was provided. Information may be provided to organizations conducting actuarial research or audits. In this case, you will not be individually identified in any research report. The organization must agree not to redisclose the Information and the Information will be returned to us or destroyed when it is no longer needed. B56 (09 -07) Page 1 of 2 INSURED We may also share your Information for other permitted purposes, including: o with another insurance company if you are involved in an accident with their insured o with our reinsurers o with insurance- support organizations that detect and prevent fraud o with medical professionals or institutions in order to verify coverage or conduct operations or services audits o with state insurance departments or other governmental or law enforcement authorities if required by law or to protect our legal interests or in cases of sus - pected fraud or illegal activities o if ordered by a subpoena, search warrant or other court order Confidentiality and Security We restrict access to your Information to employees who we have determined need it in order to provide products or services to you. We train our employees to safeguard customer Information, and we require them to sign confidentiality and non - disclosure agreements. We maintain strict physical, electronic and procedural safeguards to protect your Information from unauthorized access by third parties. Changes to This Privacy Policy Each of our policyholders receives a copy of our privacy policy at least once per year. In addition, in the event that we make a significant change to our privacy practices, we will send a revised copy of our privacy policy to each of our current policyholders. What to Do if You Have Privacy or Security Concerns If you have a concern about privacy or security at GEICO, we want to hear about it by mail or email. Please write to us at: Privacy Administration GEICO One GEICO Plaza Washington, DC 20076 or email us at privacvpolicv @oeico.com. 656 (09-07) NSURED Page 2 of 2 CALIFORNIA INSURANCE IDENTIFICATION CARD COMPANY NUMBER COMPANY NAME AND ADDRESS 22063 Government Employees insurance Company 5260 Western Ave Chevy Chase, MD 208152 POLICY NUMBER 910008260101 EFFECTIVE DATE EXPIRATION DATE 04 -17 -2016 04 -17 -2017 THIS POLICY MEETS THE REQUIREMENTS OF § 16056 OF THE CALIFORNIA VEHICLE CODE YEAR MN MODFL VEHICLE IDENTIFICATION NUMBER 2009 TOYOTA COROLLA 1N- U40E69ZO24403 AGENCY /COMPANY ISSUING CARD GEICO One GEICO Blvd. Fredericksburg, VA 22412 1- 866 -509 -9444 INSURED GOV IDVEST, INC 900 5 FIGUEROA ST APT 505 LOS ANGELES, CA 90015 -3918 SEE IMPORTANT NOTICE ON REVERSE SIDE CALIFORNIA INSURANCE IDENTIFICATION CARD COMPANY NUMBER COMPANY NAME AND ADDRESS VOID VOID VOID VOID POLICY NUMBER VOID EFFECTIVE DATE EXPIRATION DATE VOID VOID THIS POLICY MEETS THE REQUIREMENTS OF § 16056 OF THE CALIFORNIA VEHICLE CODE YEAR MAKE/MODEL VOID AGENCY /COMPANY ISSUING CARD GEICO One GEICO Blvd. Fredericksburg, VA 22412 1- 866 -509 -9444 INSURED VOID VOID VOID VOID VOID VOID VOID VOID VOID VOID VOID VOID SEE IMPORTANT NOTICE ON REVERSE SIDE INSURED VEHICLE IDENTIFICATION NUMBER THIS CARD MUST BE KEPT IN THE INSURED VEHICLE AND PRESENTED UPON DEMAND IN CASE OF ACCIDENT: Report all accidents to your Agent/Company as soon as possible. Obtain the following information: 1. Name and address of each driver, passenger and witness. 2. Name of Insurance Company and policy number for each vehicle involved. ACORD 50 CA (21104107) 02000 ACORD CORPORATION. All ngnts reserved THIS CARD MUST BE KEPT IN THE INSURED VEHICLE AND PRESENTED UPON DEMAND IN CASE OF ACCIDENT: Report all accidents to your Agent/Company as soon as possible. Obtain the following information: 1. Name and address of each driver, passenger and witness. 2. Name of Insurance Company and policy number for each vehicle involved. ACORD 50 CA (2004107 ) C 2000 ACORD CORPORATION. All ngnts reserved. INSURED THANKS FOR SELECTING US �v!Berkshire Hathaway ��4�GUAR® Insurance �' A V Companies www.guard.com In cooperation with GEICO INSURANCE AGENCY Gov Invest, Inc. 3625 Del Amo Blvd., Suite 110 Torrance, CA 90503 A WARM WELCOME FROM Berkshire Hathaway GUARD AND GEICO INSURANCE AGENCY! GEICO INSURANCE AGENCY and Berkshire Hathaway GUARD Insurance Companies are pleased to have the opportunity to serve you by providing the superior products and customer services you deserve. If you have a question about your Workers' Compensation Policy or have a particular need, our combined professional staff will be available to assist you. Contact Your Agent for: • Any inquiries about coverage issues, features that have been incorporated into your policy, and endorsements. • Requests for issuance of Certificates of Insurance. Phone: 570 -825 -9900 FAX: 570- 825 -2990 Available during regular business hours Contact Berkshire Hathaway GUARD Insurance Companies for: • Any inquiries about billing when you are under a direct bill payment plan and receive statements in the mail from us. • Questions about the status of claim or available safety services. Phone: 800- 673 -2465 FAX: 570- 823 -2059 E -Mail: csr @GUARD.com Monday through Friday; 8:00 AM to 6:00 PM EST (E -mail and voice mail after hours) To report a claim or loss, call us immediately at 888 - NEW -CLMS — 24 hours a day, seven days a week. The information below will be needed by you to complete this process. Specific instructions on reporting claims are included in the enclosed policy packet. • YOUR POLICY NUMBER IS GOWC719300. • YOUR INSURANCE CARRIER IS AmGUARD Insurance Company. • YOUR POLICY EFFECTIVE DATE IS 04/22/2016. We have also supplied a list of medical providers who are qualified to treat work injuries. Please review all attached documents carefully. Additional value -added services available to all Policyholders: • A unique Cooperative Care Program that integrates loss control, claims, and medical management activities and focuses on quality care for your injured employees and a fast return to work. • A Fraud Special Investigative Unit and Hotline at 800- 673 -2465. • AND MUCH MOREI We appreciate your business and look forward to the opportunity to serve your insurance needs. Please keep a copy of this letter with your Berkshire Hathaway GUARD Insurance Companies policy for future reference. enclosed: Workers' Compensation Policy and a customized List of Providers HQ: CA/ WC Your Business is Our Business 5m DECTO I A ' �VBerkshire Hathaway Id G U /� R ® Insurance 41A GUARD Companies Worker's Compensation and Employer's Liability Policy AmGUARD Insurance Company - A Stock Co. Policy Number GOWC719300 Renewal of GOWC648956 NCCI No. [21873], Policy Information Page 1] Named Insured and Mailing Address Gov Invest, Inc. 3625 Del Amo Blvd., Suite 110 Torrance, CA 90503 Federal Employer's ID 47- 1141591 Agency GEICO INSURANCE AGENCY 1 Geico Blvd Fredericksburg, VA 22412 Agency Code: VAAAOC11 Insured is Corporation Locations on Policy - See Extension of Information Page - [2j Policy Period From April 22, 2016 to April 22, 2017, 12:01 AM, standard time at the insured's mailing address. [3] Coverage A. Workers' Compensation Insurance - Part One of this policy applies to the Workers' Compensation Law of the following states: California B. Employer's Liability Insurance - Part Two of this policy applies to work in each of the states listed in item [3]A. The limits of our liability under Part Two are: Bodily Injury by Accident - each accident $1,000,000 Bodily Injury by Disease - each employee $1,000,000 Bodily Injury by Disease - policy limit $1,000,000 C. Other States Insurance - Part Three of this policy applies to all states, except any state listed in item [3]A. and the states of North Dakota, Ohio, Washington, and Wyoming. D. This policy includes these endorsements and schedules: See Extension of Information Page - Schedule of Forms - WC 040004 [4] Premium The Premium Basis and, therefore, the premium will be determined by our Manual of Rules, Classifications, Rates, and Rating Plans. All required information is subject to verification and change by audit. (Continued on another page) Total Estimated Policy Premium $ 610 Total Surcharges /Assessments $ 18.00 Total Estimated Cost $ 628.00 INTERNAL USE xx Page - 1 - Information Page MGA :GOWC719300 WC 000001A Date : 04/21/2016 Issuing Office: P.O. Box A -H, 16 S. River Street, Wilkes- Barre, PA 18703 -0020 • www.guard.com WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 00 03 (Ed. 7 -98) EXTENSION OF INFORMATION PAGE Schedule of Locations ITEM 1 POLICY NO. GOWC719300 (1-2) 3625 Del Arno Blvd Suite 110, Torrance, CA 90503 (04/22/2016 - 04/22/2017) Page -2- ©1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 00 04 (Ed. 7 -98) EXTENSION OF INFORMATION PAGE Schedule of Forms ITEM 3D POLICY NO, GOWC719300 Form Numbers Applicable States PN049901F - CA YOUR RIGHT TO RATING AND DIVDEND INFO • PN049902B - CA POLICYHOLDER NOTICE - WC RATING LAWS • PN049904 - CA INS. GUARANTEE ASSOC.(CIGA) SURCHARGE WCOOOOOOC - STANDARD POLICY WC000001A - INFORMATION PAGE WC000421D - CATASTROPHE(OTHER THAN CERT ACTS OF TERR WCOOD422B - TERR RISK INS PROG REAUTHORIZATION ACT • WC040003 - CA EXT OF INFO PAGE -SCH OF LOCATIONS • WC040004 - CA EXT OF INFO PAGE - SCHEDULE OF FORMS • WC040301B - POLICY AMENDATORY ENDORSEMENT - CALIFORNIA WC040303A - CA OFFICERS & DIRECTORS COVRG /EXCLUSION • WC040310 - CA DUTY TO DEFEND WC040410 - CA ESTIMATED ANNUAL PREMIUM ENDORSEMENT • WC040422 - CALIFORNIA SHORT -RATE CANCELLATION END'T • WC040601A - CA CANCELLATION ENDORSEMENT • WC990000 - AUTHORIZATION AND ATTESTATION END'T • WC990014 - CALIFORNIA CHANGES - AMENDATORY END'T * As part of our ongoing commitment to environmental responsibility throughout our operations, we have chosen not to reprint those forms (marked with an asterisk) that have not changed and were previously sent to you. You can obtain a new copy of any of these forms by accessing your account information at our Policyholder Service Center (a selection available via our web site at https: / /policyholder.guard.com). Please be aware that you will be asked to enter your policy number, policy inception date, and federal ID number in order to log on to this secure portion of our site. Alternatively, you can contact us via phone at 800 - 673 -2465; our Customer Service Representatives will either be able to help you locate a document yourself or can send a copy to your. As always, we thank you for selecting us as your insurer. We look forward to serving you! * As part of our ongoing commitment to environmental responsibility throughout our operations, we have chosen not to reprint those forms (marked with an asterisk) that have not changed and were previously sent to you. You can obtain a new copy of any of these forms by contacting us via phone at 800 - 673 -2465; our Customer Service Representatives will either be able to help you locate a document yourself or can send a copy to your. As always, we thank you for selecting us as your insurer. We look forward to serving you! INTERNAL USE xx Page - 3 - Information Page MGA : GOWC719300 Date :04/21/2016 WC OOOOOlA Issuing Office: P.O. Box A -H, 16 S. River Street, Wilkes - Barre, PA 18703 -0020 • www.guard.com a,/- Berkshire Hathaway Insurance �GUARD Companies [4] Premium (cont.) Worker's Compensation and Employer's Liability Policy AmGUARD Insurance Company - A Stock Co. Policy Number GOWC719300 Renewal of GOWC648956 NCCI No. [21873], Policy Information Page California Classification Code Premium Basis: Total Estimated Annual Remuneration Rate per $100 Remuneration Estimated Annual Premium Effective: 04/22/2016-04/22/2017 Terrorism CA 9740 0.03 250,000 75 Catastrophe 9741 0.02 250,000 COMPUTER PROGRAMMING OR SOFTWARE 8859 250,000.00 0.11 275 Territorial Rating, Los Angeles Region, Los Angeles 610 1.18 50 2 CA Fraud Surcharge 04/22/2016- 04/22/2017 0.1741% 1 CA CIGA Surcharge 04/22/2016- 04/22/2017 2.0000% otal Estimated Annual Premium for CA 12 CA SIBTF Assessment 04/22/2016- 04/22/2017 0.1191% 1 325 Policy Totals Total Estimated Standard Premium for California 325 Expense Constant 160 Terrorism CA 9740 0.03 250,000 75 Catastrophe 9741 0.02 250,000 50 Minimum Premium CA $175 Total Estimated Annual Premium 610 CA WCARF Assessment 04/22/2016- 04/22/2017 0.3433% 2 CA Fraud Surcharge 04/22/2016- 04/22/2017 0.1741% 1 CA CIGA Surcharge 04/22/2016- 04/22/2017 2.0000% 12 CA SIBTF Assessment 04/22/2016- 04/22/2017 0.1191% 1 CA UEBTF Assessment 04/22/2016- 04/22/2017 0.0532% 0 CA OSHF Assessment 04/22/2016- 04/22/2017 0.1925% 1 CA LECF Assessment 04/22/2016- 04/22/2017 0.1215% 1 Total Estimated Cost for GOWC719300 628 INTERNAL USE xx Page - 4 - Information Page MGA : GOWC719300 WC 000001A Date : 04/21/2016 Issuing Office: P.O. Box A -H, 16 S. River Street, Wilkes - Barre, PA 18703 -0020 • www.guard.com * Worker's Compensation and Employer's Liability Policy / AmGUARD Insurance /Berkshire Hathaway Com an A Stock Co. MO. Policy Number GOWC719300 �1i Insurance Renewal of GOWC648956 Pli GUARD Companies NCCI No. [21873]. Policy Information Page Policy Payment Terms INTERNAL U5E XX MGA : GOWC719300 Date : 04/21/2016 Payment Option: Direct Draft Under our Direct Draft Program, your account will be debited directly. Approximately 20 days prior to your payment due date, you will receive a Notice of Premium Due which states the amount and due date of the debit. Installment Plan (prepared 04/21/2016) Down Payment received 04/21/2016 - $628.00 Since your expiring coverage was with GUARD, please be aware that any audit premium for that policy must be paid by the date shown on the Final Audit Billing Statement to keep your current coverage in force. *Includes surcharges and state fees, if any. Page -5- Issuing Office: P.O. Box A -H, 16 S. River Street, Wilkes - Barre, PA 18703 -0020 • www.guard.com PN 04 99 01 F 03 -1 POLICYHOLDER NOTICE YOUR RIGHT TO RATING AND DIVIDEND INFORMATION Information Available to You A. Information Available from Us – AmGUARD Insurance Company (1) General questions regarding your policy should be directed to ArnGUARD Insurance Company P.O. Box A -H, 16 S. River Street, Wilkes -Barre, PA 18703-0020 800. 673.2465 (2) Dividend Calculation. If this is a participating policy (a policy on which a dividend may be paid), upon payment or non- payment of a dividend, we shall provide a written explanation to you that sets forth the basis of the dividend calculation. The explanation will be in clear, understandable language and will express the dividend as a dollar amount and as a percentage of the earned premium for the policy year on which the dividend is calculated. (3) Claims Information. Pursuant to Sections 3761 and 3762 of the California Labor Code, you are entitled to receive information in our claim files that affects your premium. Copies of documents will be supplied at your expense during reasonable business hours. For claims covered under this policy, we will estimate the ultimate cost of unsettled claims for statistical purposes eighteen months after the policy becomes effective and will report those estimates to the Workers' Compensation Insurance Rating Bureau of California (WCIRB) no later than twenty months after the policy becomes effective. The cost of any settled claims will also be reported at that time. At twelve -month intervals thereafter, we will update and report to the WCIRB the estimated cost of any unsettled claims and the actual final cost of any claims settled in the interim. The amounts we report will be used by the WCIRB to compute your experience modification if you are eligible for experience rating. B. Information Available from the Workers' Compensation Insurance Rating Bureau of California (1) The WCIRB is a licensed rating organization and the California Insurance Commissioner's designated statistical agent. As such, the WCIRB is responsible for administering the California Workers' Compensation Uniform Statistical Reporting Plan -1995 (USRP) and the California Workers' Compensation Experience Rating Plan -1995 (ERP). Contact information for the WCIRB is: WCIRB, 1221 Broadway Suite 900 Oakland, CA 94612 , Attention: Customer Service. You may also contact WCIRB Customer Service at 1- 888 - 229 -2472, by fax at 415 - 778 -7272, or via the Internet at the WCIRB's website: http: //w .wcirb.com. The regulations contained in the USRP and the ERP are available for public viewing through the WCIRB's website. (2) Policyholder Information. Pursuant to California Insurance Code (CIC) Section 11752.6, upon written request, you are entitled to information relating to loss experience, claims, classification assignments, and policy contracts as well as rating plans, rating systems, manual rules, or other information impacting your premium that is maintained in the records of the WCIRB. Complaints and Requests for Action requesting policyholder information should be forwarded to WCIRB, 1221 Broadway Suite 900 Oakland, CA 94612, Attention: Custodian of Records. The Custodian of Records can be reached by telephone at 415 - 777 -0777 and by fax at 415 - 778 -7272. (3) Experience Rating Form. Each experience rated risk may receive a single copy of its current Experience Rating Form free of charge by completing a Policyholder Rate Sheet Request Form on the WCIRB's website at http: / /www.wcirb.com /ratesheet. The Experience Rating Form will include a Loss -Free Rating, which is the experience modification that would have been calculated if $0 (zero) actual losses were incurred during the experience period. This hypothetical rating calculation is provided for informational purposes only. Dispute Process You may dispute our actions or the actions of the WCIRB pursuant to CIC Sections 11737 and 11753.1. A. Our Dispute Resolution Process. If you are aggrieved by our decision adopting a change in a classification assignment that results in increased premium, or by the application of our rating system to your workers' compensation insurance, you may dispute these matters with us. If you are dissatisfied with the outcome of the initial dispute with us, you may send us a written Complaint and Request for Action as outlined below. You may send us a written Complaint and Request for Action requesting that we reconsider a change in a classification assignment that results in an increased premium and /or requesting that we review the manner in which our rating system has 1 of 2 PIN 04 99 01 F been applied in connection with the insurance afforded or offered you. Written Complaints and Requests for Action should be forwarded to: CT Corp. System, 818 West Seventh Street, Los Angeles, CA 90017 Ph: (800) 888 -9207, FAX: (213) 614.9347, E -mail: info@ctadvantage.com After you send your Complaint and Request for Action, we have 30 days to send you a written notice indicating whether or not your written request will be reviewed. If we agree to review your request, we must conduct the review and issue a decision granting or rejecting your request within 60 days after sending you the written notice granting review. If we decline to review your request, if you are dissatisfied with the decision upon review, or if we fail to grant or reject your request or issue a decision upon review, you may appeal to the insurance commissioner as described in paragraph II.C., below. B. Disputing the Actions of the WCIRB. If you have been aggrieved by any decision, action, or omission to act of the WCIRB, you may request, in writing, that the WCIRB reconsider its decision, action, or omission to act. You may also request, in writing, that the WCIRB review the manner in which its rating system has been applied in connection with the insurance afforded or offered you. For requests related to classification disputes, the reporting of experience, or coverage issues, your initial request for review must be received by the WCIRB within 12 months after the expiration date of the policy to which the request for review pertains, except if the request involves the application of the Revision of Losses rule. For requests related to your experience modification, your initial request for review must be received by the WCIRB within 6 months after the issuance, or 12 months after the expiration date, of the experience modification to which the request for review pertains, whichever is later, except if the request for review involves the application of the Revision of Losses rule. If the request involves the Revision of Losses rule, the time to state your appeal may be longer. (See Section VI, Rule 14 of the ERP). You may commence the review process by sending the WCIRB a written Inquiry. Written Inquiries should be sent to WCIRB,1221 Broadway, Suite 900, Oakland, California 94612, Attention: Customer Service. Customer Service can be reached by telephone at 1- 888 - 229 -2472, and by fax at 415- 778 -7272. If you are dissatisfied with the WCIRB's decision upon an Inquiry, or if the WCIRB fails to respond within 90 days after receipt of the Inquiry, you may pursue the subject of the Inquiry by sending the WCIRB a written Complaint and Request for Action. After you send your Complaint and Request for Action, the WCIRB has 30 days to send you written notice indicating whether or not your written request will be reviewed. If the WCIRB agrees to review your request, it must conduct the review and issue a decision granting or rejecting your request within 60 days after sending you the written notice granting review. If the WCIRB declines to review your request, if you are dissatisfied with the decision upon review, or if the WCIRB fails to grant or reject your request or issue a decision upon review, you may appeal to the insurance commissioner as described in paragraph II.C., below. Written Complaints and Requests for Action should be forwarded to: WCIRB, 1221 Broadway Suite 900 Oakland, CA 94612, Attention: Complaints and Reconsiderations. The WCIRB's telephone number is 1- 888 - 229 -2472, and the fax number is 415- 371 -5204. C. California Department of Insurance — Appeals to the Insurance Commissioner. If, after you follow the appropriate dispute resolution process described above, we or the WCIRB decline to review your request, if you are dissatisfied with the decision upon review, or if we or the WCIRB fail to grant or reject your request or issue a decision upon review, you may appeal to the insurance commissioner pursuant to CIC Sections 11737, 11752.6, 11753.1 and Title 10, California Code of Regulations, Section 2509.40 et seq. You must file your appeal within 30 days after we or the WCIRB send you the notice rejecting review of your Complaint and Request for Action or the decision upon your Complaint and Request for Action. If no written decision regarding your Complaint and Request for Action is sent, your appeal must be filed within 120 days after you sent your Complaint and Request for Action to us or to the WCIRB. The filing address for all appeals to the insurance commissioner is: Administrative Hearing Bureau California Department of Insurance 45 Fremont Street, 22nd Floor San Francisco, California 94105 You have the right to a hearing before the insurance commissioner, and our action, or the action of the WCIRB, may be affirmed, modified, or reversed. Ill. Resources Available to You in Obtaining Information and Pursuing Disputes A. Policyholder Ombudsman. Pursuant to California Insurance Code Section 11752.6, a policyholder ombudsman is available at the WCIRB to assist you in obtaining and evaluating the rating, policy, and claims information referenced in I.A. and I.B., above. The ombudsman may advise you on any dispute with us, the WCIRB, or on an appeal to the insurance commissioner pursuant to Section 11737 of the Insurance Code. The address of the policyholder ombudsman is WCIRB, 1221 Broadway Suite 900 Oakland, CA 94612, Attention: Policyholder Ombudsman. The policyholder ombudsman can be reached by telephone at 415- 778 -7159 and by fax at 415- 371 -5288. B. California Department of Insurance — Information and Assistance. Information and assistance on policy questions can be obtained from the Department of Insurance Consumer HOTLINE, 1- 800 - 927 -HELP (4357) or http: / /www.insurance.ca.gov. For questions and correspondence regarding appeals to the Administrative Hearing Bureau, see the contact information in paragraph II.C. This notice does not change the policy to which it is attached. 2 oft WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 04 21 D (Ed. 1 -15) CATASTROPHE (OTHER THAN CERTIFIED ACTS OF TERRORISM) PREMIUM ENDORSEMENT This endorsement is notification that your insurance carrier is charging premium to cover the losses that may occur in the event of a Catastrophe (other than Certified Acts of Terrorism) as that term is defined below. Your policy provides coverage for workers compensation losses caused by a Catastrophe (other than Certified Acts of Terrorism). This premium charge does not provide funding for Certified Acts of Terrorism contemplated under the Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement (WC 00 04 22 B), attached to this policy. For purposes of this endorsement, the following definitions apply: • Catastrophe (other than Certified Acts of Terrorism): Any single event, resulting from an Earthquake, Noncertified Act of Terrorism, or Catastrophic Industrial Accident, which results in aggregate workers compensation losses in excess of $50 million. • Earthquake: The shaking and vibration at the surface of the earth resulting from underground movement along a fault plane or from volcanic activity. • Noncertified Act of Terrorism: An event that is not certified as an Act of Terrorism by the Secretary of Treasury pursuant to the Terrorism Risk Insurance Act of 2002 (as amended) but that meets all of the following criteria: a. It is an act that is violent or dangerous to human life, property, or infrastructure, b. The act results in damage within the United Stales, or outside of the United States in the case of the premises of United States missions or air carriers or vessels as those terms are defined in the Terrorism Risk Insurance Act of 2002 (as amended), and C. It is an act that has been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States orto influence the policy or affect the conduct of the United States Government by coercion. • Catastrophic Industrial Accident: A chemical release, large explosion, or small blast that is localized in nature and affects workers in a small perimeter the size of a building. The premium charge for the coverage your policy provides for workers compensation losses caused by a Catastrophe (otherthan Certified Acts of Terrorism) is shown in Item 4 of the Information Page or in the Schedule below. Schedule State Rate Premium CA 0.020 50.00 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. GOWC719300 Endorsement No. Insured Premium: Insurance Company Countersigned by WC 00 04 21 D (Ed. 1 -15) C Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 04 22 B (Ed. 1 -15) TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT DISCLOSURE ENDORSEMENT This endorsement addresses the requirements of the Terrorism Risk Insurance Act of 2002 as amended and extended by the Terrorism Risk Insurance Program Reauthorization Act of 2015. It selves to notify you of certain limitations under the Act, and that your insurance carrier is charging premium for losses that may occur in the event of an Act of Terrorism. Your policy provides coverage for workers compensation losses caused by Acts of Terrorism, including workers compensation benefit obligations dictated by state law. Coverage for such losses is still subject to all terms, definitions, exclusions, and conditions in your policy, and any applicable federal and /or state laws, rules, or regulations. Definitions The definitions provided in this endorsement are based on and have the same meaning as the definitions in the Act. If words or phrases not defined in this endorsement are defined in the Act, the definitions in the Act will apply. "Act" means the Terrorism Risk Insurance Act of 2002, which took effect on November 26, 2002, and any amendments thereto, including any amendments resulting from the Terrorism Risk Insurance Program Reauthorization Act of 2015. "Act of Terrorism" means any act that is certified by the Secretary of the Treasury, in consultation with the Secretary of Homeland Security, and the Attorney General of the United States as meeting all of the following requirements: a. The act is an act of terrorism. b. The act is violent or dangerous to human life, property or infrastructure. c. The act resulted in damage within the United States, or outside of the United States in the case of the premises of United States missions or certain air carriers or vessels. d. The act has been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. "Insured Loss" means any loss resulting from an act of terrorism (and, except for Pennsylvania, including an act of war, in the case of workers compensation) that is covered by primary or excess property and casualty insurance issued by an insurer if the loss occurs in the United States or at the premises of United States missions or to certain air carriers or vessels. "Insurer Deductible" means, for the period beginning on January 1, 2015, and ending on December 31, 2020, an amount equal to 20% of our direct earned premiums, during the immediately preceding calendar year. Limitation of Liability The Act limits our liability to you under this policy. If aggregate Insured Losses exceed $100,000,000,000 in a calendar year and if we have met our Insurer Deductible, we are not liable for the payment of any portion of the amount of Insured Losses that exceeds $100,000,000,000; and for aggregate Insured Losses up to $100,000,000,000, we will pay only a pro rata share of such Insured Losses as determined by the Secretary of the Treasury. Policyholder Disclosure Notice 1. Insured Losses would be partially reimbursed by the United States Government. If the aggregate industry Insured Losses exceed: a. $100,000,000, with respect to such Insured Losses occurring in calendar year 2015, the United States Government would pay 85% of our Insured Losses that exceed our Insurer Deductible. b. $120,000,000, with respect to such Insured Losses occurring in calendar year 2016, the United States Government would pay 84% of our Insured Losses that exceed our Insurer Deductible. c. $140,000,000, with respect to such Insured Losses occurring in calendar year 2017, the United States Government would pay 83% of our Insured Losses that exceed our Insurer Deductible. d. $160,000,000, with respect to such Insured Losses occurring in calendar year 2018, the United States Government would pay 82% of our Insured Losses that exceed our Insurer Deductible. e. $180,000,000, with respect to such Insured Losses occurring in calendar year 2019, the United States Government would pay 81% of our Insured Losses that exceed our Insurer Deductible. f. $200,000,000, with respect to such Insured Losses occurring in calendar year 2020, the United States Government would pay 80% of our Insured Losses that exceed our Insurer Deductible. 0 Copyright 2015 National Council on compensation Insurance, Inc. All Rights Reserved. WC 00 04 22 B WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY (Ed. 1 -15) 2. Notwithstanding item 1 above, the United States Government will not make any payment under the Act for any portion of Insured Losses that exceed $100,000,000,000. 3. The premium charge for the coverage your policy provides for Insured Losses is included in the amount shown in Item 4 of the Information Page or in the Schedule below. Schedule State Rate Premium CA 0.030 $75.00 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. GO W C719300 Endorsement No. Insured Premium Insurance Company Countersigned by WC 0004226 (Ed. 1 -15) 0 Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 03 A (Ed. 04 -16) ENDORSEMENT AGREEMENT LIMITING AND RESTRICTING THIS INSURANCE OFFICERS AND DIRECTORS COVERAGE / EXCLUSION — CALIFORNIA If the employer named in Item 1 of the Information Page is a private corporation whose officers and directors are the sole shareholders, this policy applies to all such officers and directors, as employees, except those excluded below or named as excluded in Item 4 of the Information Page. The insurance under this policy is limited as follows: It is AGREED that, anything in this policy to the contrary notwithstanding, this policy DOES NOT INSURE: Officers and Directors Excluded Title Nothing in this endorsement shall be held to vary, alter, waive or extend any of the terms, conditions, agreements, or limitations of this policy other than as above stated. Nothing elsewhere in this policy shall be held to vary, alter, waive or limit the terms, conditions, agreements or limitations in this endorsement. It is further agreed that "remuneration" when used as a premium basis for such insurance as is afforded by this policy shall not include the remuneration of any person excluded from coverage in accordance with the foregoing. FAILURE TO SECURE THE PAYMENT OF FULL COMPENSATION BENEFITS FOR ALL EMPLOYEES AS REQUIRED BY LABOR CODE SECTION 3700 IS A VIOLATION OF LAW AND MAY SUBJECT THE EMPLOYER TO THE IMPOSITION OF A WORK STOP ORDER, LARGE FINES, AND OTHER SUBSTANTIAL PENALTIES (Labor Code Section 3710.1, et seq.). This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.( Endorsement Effective Policy No. GOWC719300 Endorsement No. Insured Insurance Company Countersigned By WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY ESTIMATED ANNUAL PREMIUM ENDORSEMENT - CALIFORNIA WC 04 0410 (Ed. 1 -88) The premium with respect to the insurance provided by this policy by reason of the designation of California in item 3 of the Information Page is subject to experience modification. The experience modification, when issued, will be effective on _N JA your normal anniversary rating date. Pending the issuance of the experience modification by the Workers' Compensation Insurance Rating Bureau of California, the estimated annual premium shown below is based on the experience modification previously applicable to your operations. The estimated annual premium will be revised when the Bureau issues the applicable experience modification. ESTIMATED ANNUAL PREMIUM $ 628.00 The estimated annual premium shown above is based on a prior experience modification of - N /?_ - which was effective on N/A NOTE: THE ESTIMATED ANNUAL PREMIUM MAY BE INCREASED WHEN THE BUREAU ISSUES THE EXPERIENCE MODIFICATION APPLICABLE TO THIS POLICY. This endorsement changes the policy to which it is attached and is effective on the date issued unless othennnse stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Insured Policy No. GOWC719300 Insurance Company Countersigned By Endorsement No. ©1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. A �VBerkshire Hathaway �jr� GUARD Companies Gov Invest, Inc. 3625 Del Amo Blvd., Suite 110 Torrance, CA 90503 Policyholder: Gov Invest, Inc. Policy #: GOWC719300 Dear Policyholder, Berkshire Hathaway GUARD P.O. Box A -H • 16 S. River Street Wilkes- Barre, PA 18703 -0020 570-825-9900 (Toll-Free 800 - 673 -2465) FAX 570- 823 -2059 www.guard.com 4/21/2016 Thank you for selecting Berkshire Hathaway GUARD Insurance Companies as your Workers' Compensation insurer. In addition to secure coverage, we provide extensive services as part of our effort to achieve complete customer satisfaction. If a claim should happen to occur, our medical management activities are handled through another Berkshire Hathaway partner selected for this program. To better acquaint you with the information and procedures you need to know, we provide the following important Workers' Compensation and Medical Provider Network (MPN) materials: • Notice to Employees - Injuries Caused By Work (DWC 7) • Facts About Workers' Compensation • Workers' Compensation Claim Form and Notice of Potential Eligibility (DWC 1 and NOPE) • MPN Employee Handbook • Employee Notification of a Change of MPN (for introduction of a changed MPN) • Employee MPN Implementation Notice (for introduction of a new MPN) • Notice of Pharmacy Benefit Network (for introduction of a new PBN) • Employee Acknowledgement of Receipt of MPN Materials • MPN Site Coordinator Guide • On -line Directory of Managed Care Providers • Employee MPN Cessation /Termination Notice (for use upon policy cancellation or non - renewal) Each of these resources can be found on -line at: http: //w .guard.com /claims- CA.htm (Hard copies are available upon request.) PROVIDING IMPORTANT WORKERS' COMPENSATION INFORMATION Be sure to complete the Notice to Employees (DWC -7) and post in a conspicuous location frequented by employees during the hours of the workday. All employees should receive a copy of the Facts About Workers' Compensation literature. USING THE MPN MATERIALS The MPN Employee Handbook has been supplied for you to download so you can post in proximity to the DWC -7 and distribute to each person enrolled. (The document is available in English and Spanish.) If you have gone 60 days or more without an MPN, the MPN Implementation Notice should be distributed as well. If you're simply changing networks, employees should receive the Notification of a Change of MPN. The Acknowledgement of Receipt of MPN Materials must be signed and subsequently maintained as new employees are added. We also provide a Site Coordinator Guide, which is designed to assist you in the process of administering the MPN. In the event your Workers' Compensation policy is cancelled or not renewed, the MPN Cessation /Termination Notice must be downloaded and distributed to all employees. If you have any questions, do not hesitate to contact our office at 800 - 673 -2465 or csr@GUARD.com. Thank you, Customer Service Department Berkshire Hathaway GUARD A P.O. Box A -H • 16 S. River Street X Berkshire Hathaway Wilkes- Barre, PA 18703 -0020 Insurance 4� � GUARD Companies FAX 570-823-2059 570- 825 -9900 (Toll-Free www.guard.com Important Alert for Policy #GOWC719300 Please read this important advance notice which outlines our policy for handling Workers' Compensation premium for subcontractors *. If you have any questions or do not understand any portion of the explanation, we suggest you contact your agent immediately because the cost of your coverage may be affected at final audit time. Premium Charge for Subcontractors If you hire subcontractors who do not have their own Workers' Compensation insurance, your premium calculation will be modified to include any amounts paid for their labor. This additional premium is addressed in Part Five C 2 of your policy and compensates us for the risk that one or more of these subcontractors (or one of the subcontractor's employees) will file a claim for benefits under your coverage. Although subcontractors may appear to be independent businesses, claims filed by them (or their employees) are common after an injury. Under Workers' Compensation law, the legal definition of "employee" is much broader than the common understanding of that term. In addition, many states make you - as the contractor - automatically responsible for certain expenses due to work - related injuries to your independent subcontractors or their employees. Regardless of the state law, Berkshire Hathaway GUARD Insurance Companies must pay legal fees under Part One of your policy to defend these claims and must also pay Workers' Compensation benefits in many cases. For these reasons and in accordance with Part Five C 2 of your policy, we will charge appropriate additional premium unless the subcontractors have their own in -force Workers' Compensation coverage during your entire policy period, and you are able to provide acceptable proof of this coverage to us prior to completion of your final audit. Evidence of general liability insurance, pre- determinations or statements of independent contractor status, hold harmless agreements, etc. are not acceptable substitutes, and no exceptions will be made for sole proprietors or others on the grounds that such parties are not required to purchase (or cannot purchase) Workers' Compensation insurance. The risk of a claim against your policy from an uninsured subcontractor is the same, regardless of his or her reason for having no coverage. Furthermore, these additional charges will be imposed when applicable, even if exceptions have been granted to you by us or by another carrier in the past. Please realize that premium may be charged for subcontractors hired by uninsured entities owned or controlled by you. Premium will be charged if the Rating Bureau rules in your state require the related entity to be combined in a single policy with the company we are insuring. Ultimately, we believe this policy is in the best interests of all parties, and we hope that this advance notification will prevent any misunderstandings at a later date. As always, we thank you for selecting Berkshire Hathaway GUARD Insurance Companies, and we look forward to serving you during the upcoming policy year. *fbter A "subcontractor" is a person or organization paid to assist you in providing a product or service to your customer or client (and not just to you). Workers' Compensation laws in most states presume that such vendors are "employees" who, therefore, often file claims seeking benefits. PolNeq Ed. 3 2/12 R � �4" Berkshire Hathaway �X G A R D Insurance �'A 1�.i Companies Privacy Policy Berkshire Hathaway GUARD is committed to treating and using personal financial information about you and your employees responsibly. We will not disclose nonpublic, personal information about you and your employees to anyone except as permitted or required by law. This disclosure is made on behalf of AmGUARD Insurance Company. Collecting Information We collect nonpublic, personal information from you about you and your employees to properly maintain and service your policy. This nonpublic, personal information may come from the following sources: • Application Information and Other Forms. On the application for insurance or other forms completed by you, you provide us with most of the information we need to process policies and claims. • Transaction Information. We may develop information about you and your employees based on transactions and experiences you have with us, our affiliates, or others. • Third -Party Information. This is information that we receive to verify or supplement your application or claims. Disclosing Information In the course of conducting business and as permitted or required by law, we may share nonpublic, personal information about you and your employees with our affiliated companies. We do not disclose any nonpublic, personal information about you and your employees to any nonaffiliated third parties, except for the conduct of our business or as permitted or required by law. Information may be supplied to others providing business services for us. Additionally, we may provide information for audit or research purposes or to law enforcement agencies to help us prevent fraud. Securing Information We restrict access to nonpublic, personal information about you and your employees to our employees who need to know the information necessary to provide products or services to you. We maintain physical, electronic, and procedural safeguards that comply with applicable regulations to guard the nonpublic, personal information of you and your employees. AmGUARD • EastGUARD • NorGUARD • WestGUARD P.O. Box A -H • 16 S. River Street • Wilkes-Barre, PA 18703 -0020 Telephone: 570- 825 -9900 • 800- 673 -2465 A Current Copy of Our Privacy Policy is Always Available at www.guard.com SEPARATOR PAGE wc000000c WC000001A Policy Number: 9100082601 01 One GEICO Blvd. Fredericksburg, VA 22412 GOV INVEST, INC 900 S FIGUEROA ST APT 505 LOS ANGELES CA 90015 -3918 Dear Policyholder, Thank you for choosing GEICO for your Business Automobile Insurance needs. It is important you review any enclosed notices, additional coverage options, and any requests for information that we need to receive from you. We have provided you with important policy information and documents that should be kept in a safe, convenient place so you may refer to it when necessary. If you have any questions about this policy or the insurance services we offer, please contact GEICO at 1 -866- 509 -9444. We can assist you with your business auto needs as well as your personal insurance needs. If you have a loss or need to report a claim, we are available 24 hours a day and you may contact us at 1- 866 - 509 -9444. Thank you for trusting GEICO to provide the quality service your business deserves. RNGEN(09-07) Sincerely, INSURED Prr ide4 Policy Number 910008260101 COMMON POLICY DECLARATIONS Renewal Of: 9100082601 00 Government Employees Insurance Company 5260 Western Ave , Chevy Chase, MD 20815 Item 1. Named Insured and Mailing Address GOV INVEST, INC 900 S FIGUEROA ST APT 505 LOS ANGELES CA 90015 -3918 Item 2. Policy Period From: 04 -17 -2016 To: 04 -17 -2017 at 12:01 A.M., Standard Time at your mailing address shown above. Item 3. Business Description: IT COMPANY Form of Business: CORPORATION Item 4. In return for the payment of the premium, and subject to all the terms of this policy, we agree with you to provide the insurance as stated in this policy. This policy consists of the following coverage parts for which a premium is indicated. Where no premium is shown, there is no coverage. This premium may be subject to adjustment. Coverage Parts) Premium Commercial Auto (Business or Truckers) Coverage Part $ 3,260.00 Commercial Garage Coverage Part NOT COVERED Total Policy Premium $ 3, 260.00 Item 5. Forms and Endorsements Form(s) and Endorsement(s) made a part of this policy at time of issue: See Schedule of Forms and Endorsements Countersigned: Date: Authorized Representative THIS COMMON POLICY DECLARATION AND THE SUPPLEMENTAL DECLARATION(S), TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE PART(S), COVERAGE FORM(S) AND FORMS AND ENDORSEMENTS, IF ANY, COMPLETE THE ABOVE NUMBERED POLICY. CO -DEC (01 /9n NWRED Policy Number 910008260101 SCHEDULE OF FORMS AND ENDORSEMENTS Government Employees Insurance Company Named Insured GOV INVEST, INC Agent Name Stephen Found COMMON POLICY FORMS AND ENDORSEMENTS Effective Date: 04 -17 -16 12:01 A.M., Standard Time No. 67504 RNGEN 09 -07 WELCOME /RENEWAL LETTER CO -DEC 01 -97 COMMON POLICY DECLARATIONS FORM -SCHED 01 -97 SCHEDULE OF FORMS AND ENDORSEMENTS *IL 00 17 11 -98 COMMON POLICY CONDITIONS *IL 00 21 09 -08 NUCLEAR ENERGY LIABILITY EXCLUSION ENDT *IL 02 70 08 -11 CA CHANGES - CANCELLATION & NONRENEWAL AUTOMOBILE FORMS AND ENDORSEMENTS AU -DEC G 09 -07 BUSINESS AUTO COVERAGE FORM DECLARATIONS B3797A 09 -07 EXCLUSION OF PROPERTY DAMAGE B4803 09 -07 ABUSE OR MOLESTATION EXCLUSION *B4895 01 -08 ASSAULT AND BATTERY EXCLUSION *B5056 01 -11 ELIMINATION OF WORLDWIDE COVERAGE B5218 09 -07 PUNITIVE DAMAGE EXCLUSION *B54CA 09 -07 COMPOSITE AMENDMENT BA2048 08 -10 ADDITIONAL INSURED *CA 00 01 03 -10 BUSINESS AUTO COVERAGE FORM *CA 04 42 03 -10 EXCL OF FEDRL EMP USING AUTOS IN GOV BUS *CA 23 84 01 -06 EXCLUSION OF TERRORISM *CA 23 85 01 -06 EXCL OF TERRORISM INVOLVING NUC /BIO /CHEM *CA 23 94 03 -06 SILICA /SILICA- RELATED EXCL FOR COVRD AU *CA 01 43 05 -07 CALIFORNIA CHANGES CA 21 54 09 -09 CA UM COVERAGE - BODILY INJURY B316CACL 06 -10 OPTION FORM - CSL B56 09 -07 PRIVACY NOTICE *CA 20 18 12 -93 PROFESSIONAL SERVICES NOT COVERED *CA 23 01 12 -93 EXPLOSIVES *CA 23 04 10 -01 ROLLING STORES * These forms are part of this policy but are not printed FORM -SCHED (01/97) u. MAIAn IL N 119 01 15 CALIFORNIA AUTO BODY REPAIR CONSUMER BILL OF RIGHTS (This form was developed by the California Department of Insurance) A CONSUMER IS ENTITLED TO: 1. SELECT THE AUTO BODY REPAIR SHOP TO REPAIR AUTO BODY DAMAGE COVERED BY THE INSURANCE COMPANY. AN INSURANCE COMPANY SHALL NOT REQUIRE THE REPAIRS TO BE DONE AT A SPECIFIC AUTO BODY REPAIR SHOP. 2. AN ITEMIZED WRITTEN ESTIMATE FOR AUTO BODY REPAIRS AND, UPON COMPLETION OF REPAIRS, A DETAILED INVOICE. THE ESTIMATE AND THE INVOICE MUST INCLUDE AN ITEMIZED LIST OF PARTS AND LABOR ALONG WITH THE TOTAL PRICE FOR THE WORK PERFORMED. THE ESTIMATE AND INVOICE MUST ALSO IDENTIFY ALL PARTS AS NEW, USED, AFTERMARKET, RECONDITIONED, OR REBUILT. 3. BE INFORMED ABOUT COVERAGE FOR TOWING AND STORAGE SERVICES. 4. BE INFORMED ABOUT THE EXTENT OF COVERAGE, IF ANY, FOR A REPLACEMENT RENTAL VEHICLE WHILE DAMAGED VEHICLE IS BEING REPAIRED. 5. BE INFORMED OF WHERE TO REPORT SUSPECTED FRAUD OR OTHER COMPLAINTS AND CONCERNS ABOUT AUTO BODY REPAIRS. 6. SEEK AND OBTAIN AN INDEPENDENT REPAIR ESTIMATE DIRECTLY FROM A REGISTERED AUTO BODY REPAIR SHOP FOR REPAIR OF A DAMAGED VEHICLE, EVEN WHEN PURSUING AN INSURANCE CLAIM FOR REPAIR OF THE VEHICLE. COMPLAINTS WITHIN THE JURISDICTION OF THE BUREAU OF AUTOMOTIVE REPAIR Complaints concerning the repair of a vehicle by an auto body repair shop should be directed to Toll Free (866) 799 -3811 Bureau of Automotive Repair 10949 North Mather Blvd Rancho Cordova, CA 95670 The Bureau of Automotive Repair can also accept complaints over its web site at: www autorepair ca gov COMPLAINTS WITHIN THE JURISDICTION OF THE CALIFORNIA INSURANCE COMMISSIONER Any concerns regarding how an auto insurance claim is being handled should be submitted to the California Department of Insurance at (800) 927 -4357 or (213) 897 -8921 California Department of Insurance Consumer Services Division 300 South Spring Street Los Angeles, CA 90013 The California Department of Insurance can also accept complaints over its web site at: www.insurance.ca.gov INSURED COMMERCIAL AUTO Government Employees Insurance Company BUSINESS AUTO DECLARATIONS POLICY NO.: 9100082601 01 PRODUCER Stephen Found ITEM ONE NAMED INSURED: GOV INVEST, INC MAILINGADDRESS: 900 S FIGUEROA ST APT 505 LOS ANGELES, CA 90015 -3918 POLICY PERIOD: From 04 -17-20 16 to 04 -17 -2017 at 12:01 A.M. Standard Time at your mailing address shown above. PREVIOUS POLICY NUMBER: FORM OF BUSINESS: E)CORPORATION PARTNERSHIP 9100082601 00 LIMITED LIABILITY COMPANY OTHER INDIVIDUAL IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. Premium shown is payable at inception: AUDIT PERIOD (IF APPLICABLE) ANNUALLY SEMI- QUARTERLY MONTHLY ANNUALLY ENDORSEMENTS ATTACHED TO THIS POLICY: IL 0017 - Common Policy Conditions (IL 01 46 in Washington) IL 00 21 - Broad Form Nuclear Exclusion (Not Applicable in New York) SEE SCHEDULE OF FORMS AND ENDORSEMENTS COUNTERSIGNED (Date) AU -DEC G (09/07) INSURED ei7 (Authorized Representative) Page 1 ITEM TWO. SCHEDULE OF COVERAGES AND COVERED AUTOS This policy provides only those coverages where a charge is shown in the premium column below. Each of these coverages will apply only to those "autos" shown as covered "autos ". "Autos" are shown as covered "autos" for a particular coverage by the entry of one or more of the symbols from the Covered Autos Section of the Business Auto Coverage Form next to the name of the coveraae. AU-DEC G (09/07) INSURED Page 2 COVERED AUTOS (Entry of one or more of the symbols from the Coveredfrol COVERAGES Section of the LIMIT PREMIUM Business Auto THE MOST WE WILL PAY FOR ANY Coverage Fonn ONE ACCIDENT OR LOSS shows which autos are covered autos. LIABILITY 7 $1,000,000 Combined Single Limit Per PersOri Occurrence $ 2,248 Property Damage PERSONAL INJURY SEPARATELY STATED IN EACH P.I.P. PROTECTION (or equivalent ENDORSEMENT MINUS DED. No -fault Coverage) e ADDED PERSONAL INJURY SEPARATELY STATED IN EACH ADDED P.I.P. PROTECTION (or equivalent ENDORSEMENT. Aided No -fault Coverage) PROPERTY PROTECTION SEPARATELY STATED IN THE P.P.I. INSURANCE (Michigan only) ENDORSEMENT MINUS DED FOR EACH ACCIDENT. AUTO MEDICAL PAYMENTS MEDICAL EXPENSE AND INCOME LOSS BENEFITS SEPARATELY STATED IN EACH MEDICAL (Virginia only) EXPENSE AND INCOME LOSS BENEFITS ENDORSEMENT MEDICAL EXPENSE BENEFITS EACH PERSON INCOME LOSS BENEFITS EACH PERSON UNINSURED MOTORISTS $1,000,000 Combined Single Limit 7 Per Person/ Per Occurrence $ 602 Property Damage UNDERINSURED MOTORISTS (When not included in Uninsured $1,000,000 Combired Single Limit Moto rists Coverage) per Person / Per Occurrence _NCL Pnniner Dams e PHYSICAL DAMAGE COMPREHENSIVE COVERAGE ACTUAL CASH VALUE OR COST OF REPAIR, WHICHEVER IS LESS, MINUS COMPREHENSIVE/ $ 500 DED. FOR EACH COVERED AUTO, BUT NO COLLISION COVERAGE DEDUCTIBLE APPLIES TO LOSS CAUSED BY 7 FIRE OR LIGHTNING. See ITEM FOUR For Hired Or Borrowed "Autos'. S 910 COLLISION COVERAGE ACTUAL CASH VALUE OR COST OF REPAIR,WHICHEVER IS LESS, MINUS ' 500 DED. FOR EACH COVERED AUTO See ITEM FOUR For Hired Or Borrowed "Autos ". PHYSICAL DAMAGE SPECIFIED ACTUAL CASH VALUE OR COST OF REPAIR, CAUSES OF LOSS COVERAGE WHICHEVER IS LESS, MINUS DED. FOR EACH COVERED AUTO FOR LOSS CAUSED BY MISCHIEF OR VANDALISM. See ITEM FOUR For Hired Or Borrowed "Autos ". PHYSICAL DAMAGETOWING FOR EACH DISABLEMENT OF PRIVATE AND LABOR PASSENGER "AUTO". PREMIUM FOR ENDORSEMENTS TOTAL PREMIUM $ 3,260 AU-DEC G (09/07) INSURED Page 2 Business Auto Policy Amendment Government Employees Insurance Company Exclusion of Property Damage Policy Number: 9100082601 01 (to property in the care, custody or control of the insured) THIS AMENDMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This amendment modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM TRUCKERS COVERAGE FORM It is agreed that SECTION II - LIABILITY COVERAGE, B. EXCLUSIONS, 6. CARE, CUSTODY OR CONTROL is amended to read as follows: This insurance does not apply to any of the following: 6. CARE, CUSTODY OR CONTROL (a) "Property damage" to or "covered pollution cost or expense' involving property owned or transported by the "insured" or in the Insureds" care, custody or control. (b) "Property damage" to property owned by the named insured. This exclusionary clause does not apply to liability assumed under a sidetrack agreement. All other terms, conditions and agreements of the policy shall remain unchanged. This amendment is affirmed. W.C.E. Robinson Secretary B -3797A (09-07) INSURED William E. Roberts President Business Auto Policy Amendment Government Employees Insurance Company Abuse Or Molestation Exclusion Policy Number: 9100082601 01 PLEASE READ CAREFULLY This amendment modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM The following exclusion is added to the policy: This insurance does not apply to 'bodily injury" or "property damage" arising out of: (a) The alleged, actual or threatened abuse, molestation or sexual contact, whether or not intentional, by anyone or any person; or (b) The negligent: (i) Employment; (ii) Investigation; (iii) Supervision; or (iv) Retention; of anyone or negligent entrustment to anyone whose conduct would be excluded by (a) above; or (c) The reporting to authorities or failure to report to authorities the alleged, actual or threatened abuse, molestation or sexual contact by anyone of any person. All other terms, conditions and agreements shall remain unchanged. This amendment is affirmed. W.C.E. Robinson Secretary &4803 (09 -07) INSURED William E. Roberts President ACOR" CERTIFICATE OF LIABILITY INSURANCE `� DATE (MM DD YYYY) 0113012017 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 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 NAME: HONE t: (888) 202 -3007 aC No Hiscox Inc. d /b /a/ Hiscox Insurance Agency in CA 520 Madison Avenue E-MAIL ADDRESS: contact @hiscox.cOm INSURERS AFFORDING COVERAGE NAIC# 32nd Floor INSURER A: Hiscox Insurance Company Inc 10200 New York, NY 10022 INSURED INSURER B INSURER C GOVIOVest Inc. INSURER D: 3625 Del Amo Blvd INSURER E DAMAGE TO RENTED Ste 116 INSURER F: Torrance CA 90503 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 TR TYPE OF INSURANCE ADO SUBR POLICYNUMBER MMIDDY/YYYY MMILDDIYYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S DAMAGE TO RENTED GLAIMS -MADE ❑ OCCUR PREMISES Ea ocarrence $ MED UP (Any one person) S PERSONAL 8 ADV INJURY $ AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ GEN'L POLICY PRAT E] LOG PRODUCTS - COMPIOP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per Person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident S NON -OWNED HIRED AUTOS AUTOS UMBRELLA LIAR OCCUR EACH OCCURRENCE S AGGREGATE $ EXCESS LIAR CLAIMS -MADE DEB RETENTION$ $ WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY Y/N PER OTH- STATUTE ER ANYPROPRIETORIPARTN ERIEXECUTIVE E. L. EACH ACCIDENT $ OFFICEWMEMBEREXCLUDEDi F-1 NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, descdbe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ Professional Liability Each Each Claim: $ 1,000,000 A UDC - 1542150 -EO -17 02110/2017 02/10/2018 $ 2,000,000 DESCRIPTION OF OPERATIONS /LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION @ 1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE @ 1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD ACOR I , CERTIFICATE OF LIABILITY INSURANCE Ill DATE(MMMDNYYY) 01130/2017 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(ies) 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 CO MNTACT ICAO PN� Na.EaD. (888) 202 -3007 ac No]: Hiscox Inc. d /b /al Hiscox Insurance Agency in CA ADDRESS: contact @hiscox.com 520 Madison Avenue INSURERS AFFORDING COVERAGE NAICN 32nd Floor INSURER A: Hiscox Insurance Company Inc 10200 New York, NY 10022 INSURED INSURER B: MED EXP (Any one person) INSURER C: GOvIOVest Inc. INSURER D: s 3,000,000 3625 Del Arno Blvd INSURER E: s 3,000,000 Ste 110 INSURER F. Torrance CA 90503 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 LTR TYPE OF INSURANCE ADDL INSDIWVD SUER POLICY NUMBER POLICY EFF MMND POLICY UP MMIDD/YYYY LIMITS A X COMMERCIALGENERAL LIABILITY Cl-AIMS-MADE OCCUR Y UDC - 1542150- CGL -17 02/1012017 02/10/2018 EACH OCCURRENCE $ 3,000,000 PREMISES Eaoc ca $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL S ADV INJURY s 3,000,000 GENT AGGREGATE LIMIT APPLIES PER: X POLICY O JECT F—] LOC OTHER GENERAL AGGREGATE s 3,000,000 PRODUCTS - COMPIOP AGG s SIT Gen. Agg. $ AUTOMOBILELIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS A NON -OUTOS WNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ UMBRELLA LIPS EXCESS LIRE OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTIONS $ WORKERS COMPENSATION ANDEMPLOYERS'LIABILRY YIN ANYPROPRIETOR/PARTNEREXECUTIVE ❑ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes, describe antler DESCRIPTION OF OPERATIONS below NIA PER OTH- STATUTE ER E.L. EACH ACCIDENT S E L. DISEASE - EA EMPLOYEE $ E.L. DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached it more space is required) CERTIFICATE HOLDER CANCELLATION @ 1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE @ 1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD