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PROOF OF INSURANCE (2026 - 2026)AC"R " CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 08/12/2025 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 y Amusement And Event Planners Insurance Specialists p//CNNo Ext : (866) 380-3372 A/c NO): E-MAIL t li i insurances ecass ADDRESS: ae p p @yahoo.com 25422 Trabuco Rd Suite 105-406 INSURER(S) AFFORDING COVERAGE NAIC# Lake Forest, CA92630 INSURERA: Lloyd's-Beazley Group Syndicate #2623 AA-112862 INSURED INSURER B : INSURERC: Jump For Joy INSURER D 7 25200 S. Western Ave. INSURERE: 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MMIDD/YYY POLICY EXP MMIDD/YYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X CLAIMS-MADE1:1 OCCUR DA PREM SES Ea occurrDence $ 300,000 MED EXP (Any one person) $ Excluded PERSONAL & ADV INJURY $ 1,000,000 Y Y ZISMB2032 03 08/06/2025 08/06/2026 GEN'L AGGREGATE LIMIT APPLIES PER : GENERALAGGREGATE $ 2,000,000 POLICY ❑PRO ❑ LOC JECT X PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS 00/00/0000 00/00/0000 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE 00/00/0000 00/00/0000 DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE ER ANYPROFFICER/MEMBER EXCLUDED?ECUTIVE ❑ N/A OO/00/0000 OO/00/0000 E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe 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. CERTIFICATE HOLDER CANCELLATION 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 INSURED - DESIGNATED PERSON OR ORGANIZATION Policy Number: ZISMB2032 03 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(s) 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 0 MOI 03-23 COMPANY: INSURED: GEICO General Insurance Company PAUL INGERSOLL DBA PAUL INGERSOLL One GEICO Boulevard 125200 WESTERN AVE Fredericksburg, VA 22412 HARBOR CITY,CA 90710 1-866-509-9444 This memorandum is furnished t all the to you as a matter of information for your convenience. It is not intended to r7not terms and conditions or exclusions of such policies. This memorandum is not an insurance policy and does mend, 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 o suc h olr ivies: TYPE OF INSURANCE POLICY EFF. DATE EXP. DATE LIMITS SHOWN ARE AS REQUESTED NUMBER COMMERCIAL COMBINED SINGLE LIMIT $1,000,000 AUTOMOBILE LIABILITY (Ea. Accident) mm ❑ ANY AUTO BODILY INJURY ❑ ALL OWNED AUTOS 9300056818-02 07/08/2025 01/08/2026 (Per Person/ Per Accident) �... WWWW WWWW ❑ HIRED AUTOS PROPERTY DAMAGEmmmm ❑X SCHEDULED AUTOS (Per accident) ❑ NON -OWNED AUTOS ._ ...... .. .....m El _ OTHER COVERAGES COMBINED SINGLE LIMIT (Ea. Accident) ❑ ANY AUTO ❑ALL OWNED AUTOS UNINSURED MOTORISTS $300,000 ❑ HIRED AUTOS (UMCSL) ❑X SCHEDULED AUTOS 9300056818-02 07/08/2025 01/08/2026 ❑ NON -OWNED AUTOS UNDERINSURED INCL ❑ MOTORISTS (UIMCSL) UNINSURED MOTORISTS (Per Person/ Per Accident) UNDERINSURED MOTORISTS (Per Person/ Per Accident) UNINSURED MOTORISTS PD (Per accident) 4 PERSONAL INJURY PROTECTION (PIP) MED EXP CAL DAMAGE COVERAGE PHYSICAL ACTIVE VEIgICLEj, _IIIIIIII S VIN ui .........._....._ _ .._. El COMPREHENSIVE DEDUCTIBLE 2006 FORD E-350 ❑ COLLISION DEDUCTIBLE 2001 ISUZU NPR ❑ FIRE, THEFT AND SPECIFIC CAUSES OF LOSS DEDUCTIBLE 2007 FORD E-450 .... . ....... .... ......._, ....... COMPREHENSIVE DEDUCTIBLE ❑ COLLISION DEDUCTIBLE ❑ FIRE, THEFT AND SPECIFIC CAUSES OF LOSS DEDUCTIBLE Ej N/A ACTIVE DRIVERS: Paul Ingersoll, Thomas Ingersoll, Sawyer 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. 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__) 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 Idy any person in any manner so as to become subject to the workers' compensation laws of California, and glee that, if I should become subie ti th worker ' compensation provisions of Labor Code § 3700 1 must immediately t pr� greem nt-will automatically become void, Signature comply with thr m I of s or fih Date S it — f V1 Print Name Agreement for: Dated: Reviewed by: