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ABLEM-1 OP ID: S4 <br />CERTIFICATE OF LIABILITY INSURANCE <br />OAT09130D/ <br />09130!1111 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the <br />certificate holder In lieu of such endorsement(s). <br />PRODUCER 707-525-4150 <br />George Petersen Ins Agency <br />P. O. Box 3539 707-525-4175 <br />627 College Avenue <br />Santa Rosa, CA 95402 <br />CONTACT <br />PHO E <br />FAX <br />o Exti! Arc No): <br />ADDRESS: <br />INSURERS AFFORDING COVERAGE <br />NAIC X <br />Douglas DII(ey <br />INSURER A:ICW Group <br />INSURED Able Maintenance, Inc. <br />3224 Regional Parkway <br />Santa Rosa, CA 95403 <br />INSURER B: <br />PREMIE 5(Ea occurrence S <br />INSURERC: <br />COMMERCIAL GENERAL LIABILITYED <br />CLAIMS -MADE 7 OCCUR <br />INSURER D: <br />INSURER E: <br />MED EXP (Any one parson) $ <br />INSURER F; <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY. REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />ILTR <br />TYPE of INSURANCE <br />POLICY NUMBER <br />MM/DD/YY LICY 1 <br />MMlDD <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE S <br />PREMIE 5(Ea occurrence S <br />COMMERCIAL GENERAL LIABILITYED <br />CLAIMS -MADE 7 OCCUR <br />MED EXP (Any one parson) $ <br />PERSONAL 6 ADV INJURY S <br />GENERAL AGGREGATE S <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS -COMP/OP AGG S <br />POLICY F 7 PRO LOCI <br />1S <br />AUTOMOBILE <br />LIABILITY <br />EOMaBBII tlEDISINGLE LIMIT S <br />BODILY INJURY (Per person) S <br />ANY AUTO <br />ALLOVNJED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY (Per S <br />( I <br />—PROPERTY <br />NON -OWNED <br />HIRED AUTOS AUTOS <br />DAMAGE S <br />Pereccidont <br />S <br />UMBRELLA LIAR <br />HOCCUR <br />EACH OCCURRENCE 5 <br />FXGEB5 UAB <br />CLAIMS -MADE <br />AGGREGATE 5 <br />DED RETENTIONS <br />S <br />WORKERS COMPENSATION <br />WC STATU- I OTH- <br />A <br />AND EMPLOYERS' LIABILITYT12RY <br />ANY PROPRIETOR/PARTNERIEXECUTiVEYIN <br />OFFICER/MEMBER EXCLUDED? El <br />N 1 A <br />VVPL500060303 <br />10/01/11 <br />10101/12 <br />LIMITS ER <br />EL EACH ACCIDENT S 1,000,00 <br />E.L. DISEASE - EA EMPLOYEE S 1,000,000 <br />(Mandatary In NH) <br />If yes, dabcdbe under <br />DESCRIPTION OF OPERATIONS below <br />E.L DISEASE - POLICY LIMIT S 1,000,000 <br />DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It mora space Is required) <br />RE: License #312844 <br />Proof of Coverage <br />LKf]ila@ *] ItII <br />Contractors State License <br />Board -Workers Comp Unit <br />PO Box 26000 <br />Sacramento, CA 95B28 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />C, s---- <br />©1988-2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/06) The ACORD name and logo are registered marks of ACORD <br />