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PROOF OF INSURANCE (2024 - 2025) CLOSEDA C V CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 0912012023 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 CONTACT Mike Lowry rY ____ _ Amusement And Event Planners Insurance Specialists PHONE (1 (866) 380 • i°HONE _3372 ..__. FAX _.....,. tp,.�!i........... --- 25422 Trabuco Rd Suite 105-406 �DMAl _p___ss aepinslJrancespecilstsyalaoo.cam Lake Forest, CA 92630 wsuR.... - ...-. ER/SI AFFORDING COVERAGE 4I NAIC # A: Lloyd's-Beazley Group Syndicate #2623 [ AA-112862 INSURED _INSURER Jump For Joy _INSURER 25200 S. Western Ave. INSURER Harbor City, CA 90710 INSURER F: 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 ..,.... _ T.,... ADDL SUBR ... .�... ..MBER -.� .. POLICY..EFF POLICY EXP LIMITS LTR E OF INSURANCE POLICY NUMBER k' /MMADD MMIpD/YYYV1 X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 000 300,.... XCLAIMS -MADE OCCUR „PRE._MISES �Ea occur - - $ MED EXP (Any one person) $ Excluded ... _ Y Y ZISMB2032 01 08/06/2023 08/06/2024 PERSONAL & ADV INJURY .- ---- $ 1,000,000 1 00.... . ., .,..._ GEN'LAG�GRF..GwE LIMIT APPLIESPER: GENERAL AGGREGATE $ 2,000,000 POLICY C JE,p° LOC PRODUCTS COMP/OP AGG $ 2,000 000 OTHER:$ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Fa aeaderrt� $ ..... .. ...... ....._. ANY AUTO r BODILY INJURY (Per person) $ OWNED SCHEDULED OOIOOi0000 ''' OOiOOI0000 _ , ---- ( ....� BODILY INJURY Per accident) AUTOS ONLY AUTOS _ µ ..~. HIRED NON -OWNED PROPERTY OAhAAGE $ AUTOS ONLY AUTOS ONLY fpi clrleat) ................ _ (I $ UMBRELLA LIAB OCCUR j..... EACH OCCURRENCE $ EXCESSLIAB CLAIMS -MADE' 00/00/0000 00/00/0000 AGGREGATE $ .,........ ., ----- l �....._E N $ DIED RETENTION $ -- WORKERS COMPENSATION PER OTH PR ' AND EMPLOYERS' LIABILITY YIN ''.. .TATU7E /EXECUTIVE OF EXCLUDED? OFFICE PRIET EREXCLUDED'+ NIA OOIOO/DODO OO/OO/DODO ACCIDENT $ _ (Mandatory MBERNH) E L DISEASE - EA EMPLOYEE $ If yes, describe under I ( DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 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. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main St. AUTHORIZED REPRESENTATIVE El Segundo, CA 90245 Mike Lowry ©1988-2015 ACORD CORPORATION. All rights reserved„ ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL ii PERSON ORGANIZATION 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 Person(s) 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. uired 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 13 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 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. r 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 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 0 Endorsement # 2 M-2904 (11180) 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: Inconsideration of an additional premium shown below, the following coverages have been MODIFIED on the policy hereby modifying the Declarations page - M 5605 (0212011). Coverage Old Limit New Limit Coverage Old Limit New Limit Liability 50.000/100,000150,000 1,000,000 UM 50,000/100,000 1,000,000 Veh � Liab UM Premium: New Annual Premium Prorated. Premium Inc . ... PIP Med Sub ......., .............. 1 167 .. Subtotal by UM UIM PIP M Ind. Pay Vehicle ed Pay Liab UM UIM _ - 1,167 ---------� Subtotal 2,793 ........._.... .___., ,.m.�.. .����..... .� �..... Incl. 1,626 Incl 11,626 11 Pro -Rate Factor: 0.773 Old Annual: $249.00 Ali otner terms, conditions ana ,"agreements remain uncnang ea. New Annual: $710.00 Additional Premium $3,149 Return Premium $ om any blame Polic Number eWwood Fire and Casualty Insurance Company 01 , PG 134695.01 Endorsement Effective 09/29/2023 3:53 PM amed Insured Countersigned at AULINGERSOLL by Prorated: $356.00 (Authorized Representative) (The Attaching Clause need be completed only when this endorsement is issued subsequent to preparation of the policy .) M-2904 (11180) 10/0212023 MOI 03-23 o COMPANY: INSURED: GEICO General Insurance Company tL One GEICO Boulevard Fredericksburg, VA 22412 1-866-509-9444 This memorandum is furnished to you as a matter of information for your convenience. It is not intended to reflect all the terms and conditions or exclusions of such policies. This memorandum is not an insurance policy and does not amend, alter, or extend the coverage afforded by the listed policies. The insurance afforded by the listed policy is subject to all the terms, exclusions and conditions of such olicies. TYPE OF INSURANCE POLICY UMBER EFF. DATE EXP. DATE N LIMITS SHOWN ARE AS REQUESTED COMMERCIAL COMBINED SINGLE LIMIT $1,000,000 AUTOMOBILE LIABILITY (Ea. Accident) ❑ ANY AUTO . .._........... ._ BODILY INJURY ❑ ALL OWNED AUTOS 9300056818-6 07/08/2024 01 /08/2025 (Per Person/ Per Accident) ❑ HIRED AUTOS 0 SCHEDULED AUTOS DAMAGE Oaccident) ElNON-OWNEDAUTOS (Per OTHER COVERAGES COMBINED SINGLE LIMIT ❑ ANY AUTO (Ea. Accident) ❑ALL OWNED AUTOS UNINSURED MOTORISTS $300,000 ❑ HIRED AUTOS (UMCSL) 0 SCHEDULED AUTOS 9300056818-6 07/08/2024 01/08/2025 ❑ NON -OWNED AUTOS UNDERINSURED ❑ MOTORISTS (UIMCSL) UNINSURED MOTORISTS (Per Person/ Per Accident) UNDERINSURED MOTORISTS (Per Person/ Per Accident) UNINSURED MOTORISTS PD (Per accident) PERSONAL INJURY PROTECTION (,PIP) MED EXP Not Included PHYSICAL DAMAGE COVERAGE ACTIVEVEHICLE S VIN COMPREHENSIVE DEDUCTIBLE 2006 FORD E-350 mm 02 ❑ COLLISION DEDUCTIBLE 1990 FORD E-350 ❑ FIRE THEFT AND SPECIFIC CAUSES OF LOSS 78 DEDUCTIBLE 2001 ISUZU NPR I G', ,CoC I 74 19 N/A ❑ COMPRE;HENSIVE DEDUCTIBLE ❑ COLLISION DEDUCTIBLE ❑ FIRE, THEFT AND SPECIFIC CAUSES OF LOSS DEDUCTIBLE ❑ N/A ACTIVE DRIVEIS- Paul Ingersoll, MOI 03-23 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: L_) 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 Policy Number Expiration Date Name of Agent Phone # I certify that, in the performance of the work set forth in the agreement with the City of El Segundo, I will not mtoy any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should be;rn utaJect $ta_.jhe workers' compensation provisions of Labor Code § 3700 1 must immediately comply with ttr se o�isc s o�lhe agreement will automatically become void. Signature of, Pplicant - Date ' . LL Print Name ov A9 reement for: 4 m _. Dated: Reviewed by: oy ev