Laserfiche WebLink
A�-RIS CERTIFICATE OF LIABILITY INSURANCE SERVI01 pp <br />DATE (MMIDIM <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS VPON THE CERTIFICATE HOLDER- <br />THIS <br />OLDER ' <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLII <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORI <br />[---REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subjec <br />the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to <br />certificate holder In lieu of such endomement(c). <br />PRODUCER <br />George Petersen Ins Agency 707-5254150 NAPE: cT <br />P. 0. Box 3539 707-525.4175 PHONE A — <br />627 College Avenue <br />Santa Rosa CA 96402 A SS: <br />Douglas Dtlfey _ <br />IHiURER(E,�OROINO COVERAGE rlr,K <br />INSURED Service Station Systems, Inc. INSURER A ;Travelers Prop of America 25674 <br />3224 Regional Parkway <br />Santa Rosa, CA 95403 INSURER C: ` <br />Uvr_rwtaca CERTIFICATE NUMBER: <br />THIS IS t0 CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREREVISION NUMBER: <br />D <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT,NAMED ABOVE FOR THE POLICY PERKCUMENT BOTH RESPECT TO WHICH Th <br />IS SUBJECT ALL THE TERM <br />EC TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUME <br />HEREIN <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />R TYPE Of INSURANCE A- "" € <br />POLICY NUMBER MWD LIIInS <br />GENERAL L1AeIlJTY <br />EACH OCCURRENCE { <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE 11 OCCUR PREMISE oxyrrenoe { `_ <br />MED EXP I one person): <br />PERSONAL a ADV INJURY { <br />--I <br />GENL AGGREGATE LIMIT APPLIES PER. <br />POLICY PRO- LOG <br />AUTOM01111E LIABILrTY <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />HIRED AUTOS NON -OWNED <br />AUTOS <br />UMBRELLA WB OCCUR <br />EXCESS LIAR CLAIMS4AADE <br />DIEDRETENTIONS <br />WORI(ER{ COMPENSATION <br />AND EMPLOYERE' UAa1L1TY <br />A ANY PROPRIETORiPARTNER)EXECUriVE YIN <br />U86064F2133 06/04/11 06104/12 <br />{I OFFICERAIEMSEREXCLUDED7 NIA <br />ED <br />MMwsadesaibe Num <br />DESCTUPnON OF OPERATIONS I LOCATIONS I VEHICLES (AtUs h ACORD 101, Additional Ramsrks {cfiedula, A more specs Is mqulnd) <br />'roof of Coverage. <br />PRODUCTS - COMP/OP AGG I A <br />a <br />BODILY INJURY (Per Peron) { <br />BODILY INJURY (Per exJdeN) { <br />Vim'_ _ <br />(Por accJdem�. _ <br />i <br />EACH OCCURRENCE _ —T S <br />AGGREGATE I i <br />E. L_ EACH ACCIDENT j 1, <br />E_L_DISEASE; EA EMPLOYEE { 1, <br />E.L. DISEASE • POLICY LIMIT S 1: <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE well BE DELIVERED IN <br />Proof of Coverage ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIITD REPRESENTATIVE <br />qi� <br />01988.2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010106) The ACORD name and logo are registered marks of ACORD <br />