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PROOF OF INSURANCE (2022 - 2022) CLOSED (2)ACC CERTIFICATE OF LIABILITY INSURANCE °ATE08l03/2021'MM/' �'. 021 PRODUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION Amusement And Event Planners Insurance Specialists ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 25422 Trabuco Rd Suite 105-406 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Lake Forest, CA 92630 Phone (866) 380-3372 INSURER AFFORDING COVERAGE NAIC # .. ....-.-. �. m..... m . �r________ INSURED INSURER A Lloyd s Beazley Group Syndicate #2623 A A-1128623 Ron lacopucci DBA: Jump For Joy .... ........ . ........................... INSURER B: ............,.......... 530 S Francisca Ave. ..., ......................... ER C Redondo Beach, CA 90277 -INSURER INSURER D: INSURER E: COVERAGES 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, GREGATE LIMITS SHOWN MAY HAVE BEEN EDUCED BY PAID CLAIMS AGGREGATE --.. - ILTR NSCI�ES. D TYPE OF INSURANCE POLICY R.D NUMBERALYnEFDEp TIYVE P°ATE MMIDDII•y NI -- --------- -- — LIMITS 08/O6/2021 08/06/2022 1,000,000,00 A X X -UAMF.�RTZISMB1617 300 000 00 COMMERCIAL GENERAL LIABILITY �i CLAIMS MADE OCCUR (Anyone InX I PERSONAL& ADv INJURY I $ 1 000 000 00,,, IGENERAL AGGREGATE $ 2,000,000.00 GENT AGGREGATE LIMIT APPLIES PER: COMP/OP AGO I $ 2,000,000.00 1 X 1 POLICY -------� P f, ..---- LOC JECT }..PRODUCTS ......... -----...... $ .... .. ._ ..... AUTOMOBILE LIABILITY .. COMBINED SINGLE LIMIT ANY AUTO (Ea accident) I ALL OWNED AUTOS BODILY $ SCHEDULED AUTOS S person) HIREDAU70S A.(Per --- BODILY INJURY $ _ NON OWNED AUTOS (Per accident) PROPERTY DAMAGE } (Per accident) ' GARAGE LIABILITY f AUTO ONLY EA J $ ANY AUTO .... EA AAGG ....,.,.... --------------------- ---.. _,----- OTHERTHAN �.$... ......,,,,........... -_. AUTO ONLY: EXCESS/UMBRELLA LIABILITY I f EACH OCCURRENCE J $ OCCUR f CLAIMS MADE [ '... AGGREGATE $ I � $ J DEDUCTIBLE ! $ RETENTION S $ WORKERS COMPENSATION AND ICRY- LIMITS ( ER EMPLOYERS' LIABILITY - --- E.L EACH ACCIDENT $ i ANY PROPRIETOR/PARTNER/EXECUTIVE 1 --- --- -.- OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE;'; $ If----..... describe under j -.....--- ...... ......... E-L, DISEASE POLICY LIMIT 1 SPECIAL PROVISIONS below 1 SPECIAL $ OTHER I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS The City of El Segundo, It's officers, officials, employees, agents and volunteers are added as an additional insured but only with respect to liability arising out of operations of the named insured during the policy period. Amusements and Inflatables k„; .N'^k, I UP" 1k.;A I t: HULUt:t1t %,ANL r_LLA p IUF4 City of El Segundo 350 Main St.. El Segundo, CA 90245 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Mike Lowry ACORD COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ORGANIZATION Policy Number: ZISMB1617 Insured: Ron lacopucci DBA: Jump For Joy This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organizations) ............. ............. City of El Segundo 350 Main St. El Segundo, CA 90245 The City of El Segundo, It's officers, officials, employees, agents and volunteers. Information required to complete this Schedule, if not shown above will be shown in the Declarations. Section II - WHO IS AN INSURED is amended to include as an insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions of the acts or omissions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you.: CG 20 26 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 11 GEICO, (/1 0.(n V) (n Auto #4617823416 Your Policy Policy Period Drivers Premium Vehicles Your Billing This policy is paid in full. Thank you. Upcoming Payments You do not have any payments currently scheduled. Last Payment Payment for $922.94 posted on 01/22/2022. Hello, Ronald and Valerie It's nice to see you again. How can we help? Your Timeline We Also Insure: Last signed in Sun, 01/23/2022 at 03:29 PM (ET). I WOULD LIKE TO... v 01/22/2022 - 07/22/2022 Ronald lacopucci Valerie Click $920.30 2006 TOYOTA TUNDRA 1990 FORD F350 2010 TOYOTA PRIUS View Billing ummary- Get I D Cards A41 Report a Claim Don't see all your ies Qfa /Cant see all poi ' s).? `$ ro - _(c s--Vag-ma (/cross- sell/Motorcycle), sell/Umbrella). sell/PetI sell/Homeowner Motorcycle (/cross- Umbrella (/cross- Pet (/cross- 5)• sell/Motorcycle) sell/Umbrella) sell/Pet) Homeowners (/cross- sell/Homeowners) CITY OF EL SEGUNDO WORKERS' COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SUBJECTS AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN LABOR CODE § 3706, INTEREST, AND ATTORNEY'S FEES. I affirm under penalty of perjury under the laws of California one of the following declarations: (_) I have and will maintain a certificate of consent of self -insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Labor Code § 3700 for the performance of the work set forth the agreement with the City of El Segundo. Policy No. %_) I have and will maintain workers' compensation insurance as required by Labor Code § 3700 for the performance of the work for which the agreement with the City of El Segundo is executed. My workers' compensation insurance carrier and policy number are: Carrier Name of Agent Policy Number Expiration Date Phone # 91 certify that, in the performance of the work set forth in the agreement with the City of El Segundo, I will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Labor Code § 3700 1 must immediately comply with those pr ons =threement will automatically become void. 4/21 Signature of Applicant D Ron lacopucd Print Name Agreement for: Q!E 10-6-21 Dated:. Reviewed by: