Loading...
PROOF OF INSURANCE (2023 - 2024) CLOSEDDATE CERTIFICATE OF LIABILITY INSURANCE 7/17//2023 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 ce ificate holder is a ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL ^^� rt' n IONAL 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 Contact Name: I Todd Tyler Cossio Insurance Agency 9 y - . --- ........— Phone (864)688-0121 Fax PO Box 5987 (A/C, No, Ext): j (A/C, No_): Greenville, SC29606" E Mail tamm cossioinsurance com y@ (864) 688-0121 SURER(S) AFFORDING COVERAGE NAIC # INSURED _ .....................................— INSURER... .. Be................... ._................. ....... rkley Specialty Insurance Company 31295 Ultimate Attractions LLC, Dba Funco i _ — . _... _ INSURER B: erkley Life &Health Insurance Company 64890 12104 Park Street Cerritos, CA 90703 INSURE C: INSURER D: INSURER E: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: ................................................- IS IS TO CERTIFY THAT THE ES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED THE INSURED NAMED ABOVE FOR THE POLICY PERIOD OANYIREQUIREM INDICATED. ED. NOTWITHSTANDING REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR 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 . I POLICY NUMBER POLICY EFF POLICY EXP LIMITS DD SUU/BD (R /DD/YY) (MMIDD/YY) �.. X COMMERCIAL GENERAL LIABILITY Products/Completed Operations Aggr $2,000.000 CLAIMS MADE ❑X OCCUR Medical Expenses (any one person) Excluded Damage to Premises Rented to you $100,000 a BI/PD Combined Deductible Per Clai $2,500 A X BPK0175648-20 10/5/2022 10/5/2023 Personal & Advertising Injury (Any O $1,000,000 GEN L AGGREGATE LIMIT APPLIES PER Each Occurrence $1,000.000 X POLICY PROJECT �LOG General Aggregate $2,000,000 OTHER: ,.,,,,, AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ....... ........ ALL OWNED '�II SCHEDULED BODILY INJURY (Per Person) $ I AUTOS �,,,,.,.0 AUTOS I , , , , ,,,,,,, , ,,...... HIREDAUTOS ..p NON -OWNED BODILY INJURY (Per accident) $ ..N AUTOS n ..__ PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR e_,------,, �..... ,..�. „ , ,,,........ EXCESS LIAB CLAIMS -MADE ED ❑ RETENTION $ WORKERS COMPENSATION ... PER QTH- AND /XE STATUTE ER ANYA PROPRIEETOR/ RTNEBRECUTIVE Y/N i OFFICER/MEMBER EXCLUDED. N/A ' (Mandatory in NH) ❑ If yes, describe under 1 DESCRIPTION OF OPERATIONS below f Total Benefit Maximum for all Accident M $25 000 j Class 1 Principal Sum $25,000 B f Accident Medical PAI L012010778503 10/5/2022 Benefit Maximum $500,000 i Accident Medical Deductible $100 [7/2023 DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACORD 101, Additionalrequired) Remarks Schedule, may be attached if more wired) Party Equipment Rentals Operations located at 12104 Park St. Cerritos, CA 90703. Certificate Holder is listed as additional insured when required by written contract. Amusement devices on file with the company for special event(s) dated 8/01/2023 to 08/01/2023 located at El Segundo Police Department 348 Main St. El Segundo, CA. 90245 Officers, agents, volunteers, and employees as additional insured. CERTIFICATE HOLDER: . mm . .............. ...� CANCELLATION ....... .........._ El Segundo Police Department -- �SHOULDANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 348 Main St. THE ION D ATE THEREOF, NOTICE WILL BE DELIVERED IN El Segundo, CA. 90245 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: BPK0175648-20 COMMERCIAL GENERAL LIABILITY CG 20 11 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE m 348 Main St. El Segundo, CA. 90245 Name Of Person(s) Or Organization(s) (Additional Insured): El Segundo Police Department 348 Main St. 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 include as an additional 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 you or those acting on your behalf in connection with the ownership, maintenance or use of that part of the premises leased to you and shown in the Schedule and subject to the following additional exclusions: This insurance does not apply to: 1. Any 'occurrence" which takes place after you cease to be a tenant in that premises. 2. Structural alterations, new construction or demolition operations performed by or on behalf of the person(s) or organization(s) shown in the Schedule. However: 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. 1. The insurance afforded to such additional This endorsement shall not increase the applicable limits of insurance. insured only applies to the extent permitted by law; and CG 20 11 12 19 0 Insurance Services Office, Inc., 2018 Page 1 of 1 ACORD CERTIFICATE OF LIABILITY INSURANCE 07/1si202n3 ' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Baig Insurance Agency Plus ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 18301 Pioneer Blvd. Ste. B HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Artesia, CA - 90701 Faiz Baig - 562.403.1786 INSURERS AFFORDING COVERAGE NAIC # INSUREDINSURERA y Ultimate Attractions LLC DBA: Funco INSURERB. _ ITi%.O ief.S. C eI I .(OSLIIBCCGI.m .4 ____ ...1.0346.,, , ..... 04 Park Street INsuRERc: u __ ..................... ..................... ...................... Cerritos, CA 90703 INSURER D. . .....----------- INSURER E: 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR61 ......................... ._..... ....... �y V LTR NSRD TYPE OF INSURANCE POLICY NUMBER A (MMIL'JF A E (MM/DDIY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ G MMERCLAL GENERAL LIABILITY N'AFv'K6E7-0-REN ... PREMISES (Ea OCLA renoe �� .._._.. $ ] CLAIMS MADE OCCUR MED EXP (Any one gsersrnrt $ PERSONAL& ADV INJURY $ GENERALAGGREGATE $ GEN'L AGGREGATE LIMIT APP'UFS PER: ..,..,—....�. PRODUCTS COMP/OP AGG $ POLICY JE LOC I _-................................................. AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULEDAUTOS (Per person) HIREDAUTOS _.......................... ............. , , , ,................... _ W .. BODILYINJURY $ _ NON -OWNED AUTOS (Per accident) ,._.........._.........,........"......................_ '.... PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY- EAACCIDENT $ ANY AUTO OTHERTHAN EA ACC $ AUTOONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCEEl $ OCCUR E 1 CLAIMS MADE AGGREGATE $.................................. DEDUCTIBLE RE'LEN'nON $ $ WORKERS COMPENSATION AND IWCSTAIU- TORY LIMITS ER A EMPLOYERIETORIILITY _ . _ ..._........................_.... 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE EIG-4790364-01 06/01/2023 06/01/2024 _-......_ E�L EACH ACCIDENT """ -.W $ ""- - OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under.W--.. -- SPECIAL PROVISIONS below E.L. DISEASE-mPOLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS El Segundo Police Department 348 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 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LPA. LY OF ANY KIND UPDN E INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTAnV . ACORD 25 (2001/08) © ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/08)