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PROOF OF INSURANCE (2022 - 2023) CLOSEDDAT CERTIFICATE OF LIABILITY INSURANCE 4/18/2022 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 have ADDITIONAL INSURED provisions or 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 Cossio Insurance Agency PO Box 5987 Greenville, SC 29606 (864)688-0121 INSURED Cal Jump Inc 4825 Rosecrans Ave Hawthorne, CA 90250 Contact Name: Todd Tyler (864)688-0121 Fox ._ .(AFC E-Mail: shay@cossioinsurance.com INSURER(S) AFFORDING COVERAGE INSURER A: Aegis Security Insurance Company INSURER B: INSURER C: INSURER D: INSURER E: NAIC # 33898 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 ... TYPE OF POLICY .. ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSRI WVD (MM/DD/YY) (MM/DD/YY) ........ ------- X COMMERCIAL GENERAL LIABILITY ---- - ..... ... .......................... .. Aggregate Limit Excluded ❑ ❑ CLAIMS MADE X❑ OCCUR Each Common Cause Limit Excluded Abuse or Molestation Aggregate Limi Excluded ❑I Abuse or Molestation Each Incident L Excluded I A X CIL-001274 4/9/2022 4/9/2023 Hired and Non -Owned Auto Liability Excluded Each Occurrence Limit $1.000,000 '.. GEN'L AGGREGATE LIMIT APPLIES PER X POLICY ❑PROJECT ❑LOC General Aggregate Limit $2,000,000 Products/Completed Operations Aggr $2,000 000 ❑ OTHER: Personal & Advertising Injury Limit $1,000 000 -- AUTOMOBILE LIABILITY .... ..... ------- ..... COMBINED SINGLE LIMIT $ ❑ ANY AUTO (Ea accident) ALL OWNED SCHEDULED � BODILY INJURY (Per Person) $ ❑ AUTOS AUTOS ..,._ ❑ HIREDAUTOS NON -OWNED BODILY INJURY (Per accident) $ AUTOS -— ------ — PROPERTY DAMAGE $ ❑ .�� (Per accident) ❑ UMBRELLA LIAB ❑ OCCUR ❑ EXCESS LIAB ❑ CLAIMS -MADE ❑ DED ❑ RETENTION $ ..................................................................1,........ ...._......._.._ -- WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below A I Accident Medical UI CIA-001259 ( 4/9/2022 ATUTE ( ER Deductible Amount Per Covered Person $100 Maximum Benefit Amount Per Covered P $25,000 4/9/2023 Loss Period after Accident 90 Days Full Excess Medical Expense $25,000 Principal Sum $25.000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Party Equipment Rentals Operations located at 4825 Rosecrans Avenue Hawthorne, CA 90250. Certificate Holder is listed as additional insured perform CG2011 when required by written contract. The certificate holder is added as an additional insured, but only for liability caused, in whole or in part, by the acts or omissions of the named insured, Amusement devices on file with the company for special event(s) dated 4/19/2022 to 4/19/2022 located at 401 Sheldon Street, El Segundo, CA 90245. CERTIFICATE HOLDER: The City Of El Segundo, Its Officers, Officials, Employees, Agents, And Volunteers 401 Sheldon Street El Segundo, CA 90245 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. REPRESENTATIVE _ @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: CIL-001274 COMMERCIAL GENERAL LIABILITY CG 20 11 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -MANAGERS OIL LESSORS OF' PRE iISES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designation Of Premises (Part Leased To You): Name Of Person(s) Or Organization(s) (Additional Insured): The City Of El Segundo, Its Officers, Officials, Employees, Agents, And Volunteers 401 Sheldon Street El Segundo, CA 90245 Additional Premium: $ Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to 2. If coverage provided to the additional insured include as an additional insured the person(s) or is required by a contract or agreement, the organization(s) shown in the Schedule, but only insurance afforded to such additional insured with respect to liability arising out of the will not be broader than that which you are ownership, maintenance or use of that part of the required by the contract or agreement to premises leased to you and shown in the provide for such additional insured. Schedule and subject to the following additional B. With respect to the insurance afforded to these exclusions: additional insureds, the following is added to This insurance does not apply to: Section III — Limits Of Insurance: 1. Any 'occurrence" which takes place after you If coverage provided to the additional insured is cease to be a tenant in thatpremises. required by a contract or agreement, the most we 2. Structural alterations, new construction or will pay on behalf of the additional insured is the demolition operations performed by or on amount of insurance: behalf of the person(s) or organization(s) 1. Required by the contract or agreement; or shown in the Schedule. 2. Available under the applicable Limits of However: Insurance shown in the Declarations; 1. The insurance afforded to such additional whichever is less. insured only applies to the extent permitted by This endorsement shall not increase the law; and applicable Limits of Insurance shown in the Declarations. CG 20 11 0413 ©insurance Services Office, Inc., 2012 Page 1 of 1 MOJAVE INS AGY LLC 2410 DECATUR BLVD 120 LAS VEGAS, NV 89108 1-702-625-6348 Certificate of Insurance Policy number: 04285933-0 Underwritten by: United Financial Cas Co May 6, 2022 Page 1 of 1 Certificate Holder Loss Payee PRIUS PLANET 23022 LA CADENA DRIVE SUITE 105 LAGUNA HILLS, CA 92653 Insured Agent/Surplus Lines Broker CAL JUMP INC MOJAVE INS AGY LLC 15705 CONDON AVE UNIT# D3 2410 DECATUR BLVD 120 LAWNDALE, CA 90260 LAS VEGAS, NV 89108 This document certifies that insurance policies identified below have been issued by the designated insurer to the insured named above for the period(s) indicated. This Certificate is issued for information purposes only. It confers no rights upon the certificate holder and does not change, alter, modify, or extend the coverages afforded by the policies listed below. The coverages afforded by the policies listed below are subject to all the terms, exclusions, limitations, endorsements, and conditions of these policies. 10, 2022 Policy Expiration Date ... ....... .......... ... .... Policy Effective Date. J� cy p Dece10, 2022 Description of Location/Vehicles/Special Items Scheduled autos only 2018 MERCEDES-BENZ SPRINTER 2500 WD3PE7CD9J.P.................................................. ....................... ............................ 625054 Comprehensive $500 Ded Collision $500 Ded Certificate number 12622A16933 Please be advised that additional insureds and loss payees will be notified in the event of a mid-term cancellation. Form 5241 (10/02)