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PROOF OF INSURANCE (2024 - 2024) CLOSEDAC"REPCERTIFICATE OF LIABI......,..LITY INSURANCE DAT8/0112023Y) 08/01 /2023 PRODUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION Amusement And Event Planners Insurance Specialists ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 25422 Trabuco Rd Suite 105-406 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Lake Forest, CA 92630 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # Phone: (866) 380-3372.... ................ ......... ........ ...... INSURED INSURER A: Lloyd's-Beazley Group Syndicate #2623 AA-1128623 Jump For Joy INSURE ..... ........ ................. ........ ......... R B: 25200 S. Western Ave. INSURER C: Harbor City, CA 90710 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. .'..........INS . ADDS...,,,,,,,,,,,,,_,,,,,,,,m____,m,,,..._,,,..._,,,....____...........,,,,...,,,,,,,,,,.___.,,_,,,,,,,.,,,,,,,,................................... ...... POLICY EFFECTIVE EXPIRATION _... .......................... ..."............................"".,�..-" .....................""................... LTR INSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MWDD/YY LIMITS GENERAL LIABILITY ZISMB2032 01 08/06/2023 08/06/2024 EACH OCCURRENCE $ 1,000,000.00 A X X COMMERCIAL GENERAL LIABILITY T&L"91FC P EMILSEEa renae) $ 300,000.00 X CLAIMS MADE II OCCUR MED EXP (Any oneperson) $ Excluded PERSONAL&ADVINJURY $ 1,000,000.00 RAL.. GENE AGGREGATE _"...._. $ 2,000,000.00 GEN L AGGREGATE LIMIT A APPLIES PER: PRODUCTS COMPIOP AGG" � 2 g 00,000.00 O ...... DER O........... ...._.. ._,� .... ..... _"""".".... X POLICY LOC $.... AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) .......°.°.°.°.°.°.°......°.... $ ................................................._............ .... HIRED AUTOS BODILY INJURY NON -OWNED AUTOS ( ) ............."."......................................... ............ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC- ._$..."..........................."................... . AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE „,,,.... AGGREGATE ,,1.... $ ..........m._..- _�...,.....,.�..._..............._. $ DEDUCTIBLE $1TAT�._ RETENTION $ WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS' LIABILITY _. E L EACH ACCIDENT II $ ANY PROPRIETOR/PARTNER/EXECUTIVE E,LDISEASE -EA EMPLOYE $ OFFICER/MEMBER EXCLUDED? If yes, describe under ""'- ........ SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / 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 (;1zK I It IL;AtI HULLI City of El Segundo 350 Main St. El Segundo, CA 90245 t;ANlL;hL.LA I JU N 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 25 (2001108) © ACORD CORPORATION 1988 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ORGANIZATIONADDITIONAL INSURED - DESIGNATED PERSON OM I Policy Number: ZISMB2032 01 Insured: Jump For Joy This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE _.. .. .......... —.-- Name Of Additional Insured Persons 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 ❑ COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF FIGHTS OF RECOVERY AGAINST OTHERS TO IDS This endorsement modifies insurance provided under the following: Policy Number: ZISMB2032 01 Insured: Jump For Joy COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: 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. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations_ hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 06 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 13 Endorsement # 2 GENERAL CHANGE ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement changes the policy on the inception date of the policy or on the date shown below, It is agreed that the policy is changed as follows: In consideration of an additional premium shown below, the following coverages have been MODIFIED on the policy hereby modifying the Declarations page - M 5605 (021 2011). Coverage Old Limit New Limit Coverage Old Limit New Limit Liability 50,0001100,000150,000 1,000,000 UM 60,000/100,000 1,000,000 M-2904 (11/80) New Annual Premium Prorated Premium ........ . .. --.... „ ............ ........... Veh Liab UM UIM PIP Med Pay Liab UM UIM PIP Med Subtotal by # _ ..... ., .. .., ' ?,.,.,Pay Vehicle ..�......, 1 3,473i Incl.; 1,167 Incl., 1,167 .... ...... ,.-----....- --............ ..... ....eeeeeeee........... _ --- ..... ...... ... ,.......... ,,. .. 2 4,839, Incl, 1,626 Incl, 1,626 Subtotal 2,793 UM Premium: Old Annual: $249.00 Pro -Rate Factor: 0.773 All other terms, conditions and agreements remain un New Annual: $710.00 Additional Premium $3,149 Return Premium $ Prorated: $356.00 om any Name Poll Number Reywood Fire and Casualty Insurance Company 01 Poll 134695 - 01 Endorsement Effective 09/29/2023 3:53 PM amed Insured Countersigned at AULINGERSOLL by (Authorized Representative) (The Attaching Clause need be completed only when this endorsement is issued subsequent to preparation of the policy ,) M-2904 (11/80) 10/02/2023 CALIFORNIA COMMERCIAL/FLEET INSURANCE IDENTIFICATION CARD Company Name: Redwood Fire and Casualty Insurance Company Company Address: 1314 Douglas Street Omaha, NE 68102 NAIC No.: 11673 Name of Policyholder: PAUL INGERSOLL 26200 WESTERN AVE Address of HARBOR CITY, CA 90710 Policyholder: Policy No. Effective Date Expiration Date 01APG134695-01 07108/2023 12:01 AM 07/08/2024 12:01 AM Vehicle Year Make/Model Vehicle Identification No. 1990 FORD F37 The policy meets the requirements of the California Vehicle Code Sections 16056 or 16500„5 and is a commercial or fleet policy. M-4566a (1111999) CALIFORNIA COMMERCIALIFLEET INSURANCE IDENTIFICATION CARD Company Name: Redwood Fire and Casualty Insurance Company Company Address: 1314 Douglas Street Omaha, NE 68102 NAIC No.: 11673 Name of Policyholder: PAUL INGERSOLL 25200 WESTERN AVE Address of HARBOR CITY, CA 90710 Policyholder: Policy No. Effective Date Expiration Date 01APG13469"1 07/0812023 12:01 AM 071081202412:01 AM Vehicle Year Make/Model Vehicle ldentsficatron . 1990 FORD F37 The policy meets the requirements of the California Vehicle Code Sections 16056 or 16500.5 and is a commercial or fleet policy. M-4566a (1111999) VERY IMPORTANT - Please Read In the event of accident, be sure to secure license number of the other vehicle, also full names and addresses of all other persons in the accident. Also, write down full names and addresses of all witnesses. Report at once full details of accidents to your insurance company's Claim Operations, PO BOX 31361, Omaha, NE 68131-0361. Toll Free 1-800-691-3891 (This identification card should be kept in your vehicle.) VERY IMPORTANT - Please Read In the event of accident, be sure to secure license number of the other vehicle, also full names and addresses of all other persons in the accident. Also, write down full names and addresses of all witnesses. Report at once full details of accidents to your insurance company's Claim Operations, PO BOX 31361, Omaha, NE 68131-0361. Toll Free 1-800-691-3891 (This identification card should be kept in your vehicle.) CALIFORNIA COMMERCIALIFLEET INSURANCE IDENTIFICATION CARD Company Name: Redwood Fire and Casualty Insurance Company Company Address: 1314 Douglas Street Omaha, NE 68102 NAIC No.: 11673 Name of Policyholder: PAUL INGERSOLL 25200 WESTERN AVE Address of HARBOR CITY, CA 90710 Policyholder: Policy No. Effective Date 01APG134695-01 07/0812023 12:01 AM Vehicle Year Make/Model 2006 FORD E35OSD VERY IMPORTANT - Please Read In the event of accident, be sure to secure license number of the other vehicle, also full names and addresses of all other persons in the accident. Also, write down full names and addresses of all witnesses. Expiration Date Report at once full details of accidents to your insurance 07108/2024 12:01 AM company's Claim Operations, PO BOX 31361, Omaha, NE Vehicle iderdli is No. 68131-0361. Toll Free 1-800-691-3891 The policy meets the requirements of the California Vehicle Code Sections 16056 or 16500.5 and is a commercial or fleet policy. M-4566a (1111999) (This identification card should be kept in your vehicle.) CALIFORNIA COMMERCIALIFLEET INSURANCE IDENTIFICATION CARD Company Name: Redwood Fire and Casualty Insurance Company Company Address: 1314 Douglas Street Omaha, NE 68102 VERY IMPORTANT - Please Read NAIL No.: 11673 In the event of accident, be sure to secure license number of Name of Policyholder: the other vehicle, also full names and addresses of all other Address of 2520PAUWESTEINGERSRN 25200 WESTERN AVE persons in the accident. HARBOR CITY, CA 90710 Policyholder: Also, write down full names and addresses of all witnesses. Report at once full details of accidents to your insurance Policy No, Effective Date Expiration Date 01APG134695-01 07108/2023 12:01 AM 071081202412:01 AM company's Claim Operations, PO BOX 31361, Omaha, NE Vehicle Year Make/Model Vehicle Identification No. 68131-0361. 2006 FORD E35OSD Toll Free 1-800-691-3891 The policy meets the requirements of the California Vehicle Code (This identification card should be kept in your vehicle.) Sections 16056 or 16500.5 and is a commercial or fleet policy. M4566a (11/1999) 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: U 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. (U 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 # An I certify that, in the performance of the work set forth in the agreement with the City of El Segundo, I will not Joy any person in any manner, so as to become subject to the workers' compensation laws of California, and agree that, if I should become object to the workers' compensation provisions of Labor Code § 3700 1 must ,jhe agreement will automatically become void. Signature of A comply it thys oyis�� orm. ��_.,..., � `� Date Print Name Agreement for: Dated: h _ nce Approval: Reviewed by: ""'""