PROOF OF INSURANCE (2013) CLOSEDSep 12 12 10'.20a Jump For Joy (310) 316 -8769 p,2
DATE IMWDWYYYY)
AC<>R L> CERTIFICATE OF LIABILITY INSURANCE 9/10/12
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 rerli ficate holder is an AIDDITIONAL INSURED, the policy(ios) must bi endorsed. I SUBItO A'TIo IS WAl'VJED„ subject to
the terms and conciltlons 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).
ON A T
PRODUCER NAME!.
Py)ONE
FAX
Thompson Insurance Enterprises LLC (ArF,NN�, ._ _ m._ ?��?P._.._
3380 Chastain Meadows Parkwayi 21:
Suite 100 PRODUCCR
Kennesaw, GA 30144 , — INSUiRERIS) AFFORDING COVERAGE � J NA
Ics
INSURED NNSUREPI A a
Ron lacopucci DBA:Jump ForJoy 14SUHERB
530 5 Francisca Ave INSURER c ;
Redondo Beach, CA 90277 INSURERO:
COVERAGES CERTIFICATE NUMBER( 371071 REVISION NUMBER:
THIS IS TO CERTIFY THATTHE 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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 LIAY HAVE BEEN
I TYPEOFI - ITITITITITITIT ITIT REDUCED BY PAID TM CLAIMS.
..
.., ..
NR T- od IT
LIMITS
LTR GENERAL LIABILITY NSURANCE POLICY dYe ()AD D!YY EA CH OCCURRENCE s
1 f0O. .
'p" O
0
L" TO RELATE O..
X COMMERCIAL GENERAL LIABILITY PREMIGSIEeerRA $10ItiGlt_
CLAIMS -MADE 1 OCCUR X FPG20002450 -00 9/14/12 9/14/13 MEDEXP!AmIn!22 -r -) s ExclV.uded,m
A . . ............._
PERSONALS ADV INJURY S 1,000Oi0
HWL AG REOATE LIMIT APPLIES PER:
X POLCCY PR1
LOG
AUTOMOBILE LIABILITY
....
ANY AUTO
S
(Ea accideN)
ALLOWNED
BODILYINJURY(PerpsrSan)
SCHEDULED
BODILY INJURY (Per accident)
AUTOS
P ERTY DAMAGE
AUTOS
(Per accident)
HIRED AUTOS
NON - OWNED
' TOR s1'A)U
AND EMPLOYERSUABILITY YIN
AUTOS
GENERALAGGREGATE
N
s ,2 000 00
PRODUCTS - CCMP10PAGG
S included
COMBINED SINGLE UMIT
S
(Ea accideN)
BODILYINJURY(PerpsrSan)
S
BODILY INJURY (Per accident)
3
P ERTY DAMAGE
_
(Per accident)
S
I
UMBRELLALIAB OCCUR
EACHOCWRRENi
EXCE SS LIAR ej CL..AIM. .&�MAD_ E
.....
AGGREGATE
DED RETENTIONS
YO
VRKERS COMPENSATION
' TOR s1'A)U
AND EMPLOYERSUABILITY YIN
ANY PROPR1Ei0RtP4RTNERIEXECUTIVI
FE
OFFICER. MEMBER EXCL EOP
NIA
SEAS EA
IMandotery In NHII
VGy,+as, deuabeun�isr — li 9. I 1 1 l E.L. DISEASE - PO
B Accident and Health SRG9111252- 2027 -01 9114/12 19114113
DESCRIPTION OF OPERATIONS! LOCATIONS/ VEHICLES (Attach ACORD 101, Addift..1 RemarksSehed.k. If more space Is required)
Inflatable Rentals & Party Rental Services for
The City of El Segundo, it's officers, officials, employees, angents, and volunteers
CERTIFICATE HOLDER
City of El Segundo
350 Main St
El Segundo, CA 90245
ACORD 25 (2010105)
ON
S
4
S
S
s
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRIESCWTATNE
010, 1
Ole-
�- C) 1988.2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Sep 121210:21a Jump For Joy
POLICY NUMBER: FPG20002450 -00
(310) 316 -8769 p.3
COMMERCIAL GENERAL. LIABILITY
CG 20 26 07 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
ADDITIONAL INSURED - DESIGNATED
PERSON OR ORGANIZATION
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, its officers, officials, employees, agents and volunteers.
350 Main St.
El Segundo, CA 90245
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Section 11— Who is An Insured is amended to include as an additional insured the person(s) or organizations(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 or the acts or omissions of those acting
on your behalf
A. In the performance of your ongoing operations; or
S. In connection with your premises owned by or rented to you.
Endorsement
Name Insured: Ron lacopucci - Jump For Joy
Effective Date: 911412012 — 911412013
Additional Premium: 0.00
CG 20 26 07 04 0 Thompson Insurance Enterprises/FunPro Page 2 of 2
Jul 19 12 01:11 p Jump For Joy
(310) 316 -8769 p.3
TRAVELERS J
AUTOMOBILE POLICY DECLARATIONS
1. Named Insured
RON 6 VALERIE IACOPUCCI
530 S FRANCISCA AVE UNIT B
REDONDO BEACH CA 902774241'
Your Policy Number : 941113867 101 1
Your Account Number: 941113867
Your Service Center Address
KNOXVILLE BUSINESS CENTER
P O BOX 59059
KNOXVILLE TN 379509059
For Policv Service Call 1-800- 842 -5075
For Claim Service Call 1- 800- CLAIM33
2. This is change number 1, which is effective February 1, 2012.
• This change causes no additional or return premium for the policy period.
• The policy period is from February 1, 2012, 12;01 a.m. tea,
These declarations replace all prior automobile policy d eclarations on i,he
date on which this change is effective.
3. Your Vehicles
Identification Numbers
1
2006
TOYOT TUNDRA LIM
STBDT481265519837
2
1990
=ORD F350
2E"DRF37bnLCA88678
3
2000
TOYOT ECHO
%TTDBT1236Y0067520
4
2001
TOYOT AVALON XL/
4T1BF28B11U131498
4: Coverages, Limits of Liability and Premiums
Insurance is provided only where a premium is shown for the coverage„
1 2 3
A - Bodily Injury
$100,000 each person
$300,000 each accident
B - Property Damage
$50,000 each accident
DI - Uninsured /Underinsured Motorists
Bodily Injury
$100,000 each person
$300,000 each accident
See Endorsement A04044
E - Calliaiod
Actual Cash Value less
$2,500 deductible
F - Comprehensive
(Other than Cvllisiorn)
Actual Cash Value leas
$2,500 deductible
Continued on next page
FL- 77036 -94 87L /0M1906
06 TOYOT 90 FORD 00 TOYOT
TUNDRA LIM F350 ECHO
$ 315 $ 173
Incl-* Incl*
61 35
122 -
17 -
$ 129
Incl*
25
23
8
00013WOMS F31f5AHA 7561 02/2'112
4
01 TOYOT
AVALON XL/
S 525
Incl*
103
62
11
Page 1 of 4
Jul 1912 01:12p Jump For Joy (310) 316 -8769 pA
JUMP FOR JOY
530 S. Francisco Ave., Redondo Beach, Ca 90277
Phone (310) 316 -0158 Fax (310) 316 -8769
July 19, 2012
r
To Whom It May Concem
1, Ron lacopucci own Jump for Joy which is a sole proprietorship business. Since
I am a sole proprietor, I do delivery work etc., myself. I am not required to carry
Workers' Comp. Insurance.
�` rely
Ron l Gucci