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SERVI01 OP ID; <br />CERTIFICATE OF LIABILITY INSURANCE OAT06/03D/YYYYJ <br />6l03/11 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THI! <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIE! <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZE[ <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 WANED, subject tc <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 707-525.4150LC rACT <br />George Petersen Ins Agency PE:P. O. Box 3539 707-525 4175ONodi_T(ac, Nol:620 College Avenue -- Santa Rosa, CA 95402 DDRIESS: <br />Douglas Dilley INSURER(SLAFFOROINO COVERAG-- <br />E NAIL a <br />� — <br />INSURED Service Station Systems, Inc. <br />3224 Regional Parkway <br />Santa Rosa, CA 95403 <br />INSURER : Travelers Prop Cas of America <br />COVERAGES CERTIFICATE NUMBER: A - 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 />NSR TYPE OF INSURANCE AD b -L — — POL C EF POLICY EXP ~ <br />POLICY NUMBER i MWDDIYYYY MMID Llmrs <br />GENERAL LIABILITY <br />EACH OCCURRENCE S <br />COMMERCIAL GENERAL LLABILITY PREMISES Ee aecunence S ' <br />_J CLAWS -MADE D OCCUR ---- <br />GEN1 AGGREGATE LIMIT APPLIES PER: <br />POLICY I I PRC n LOC <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />ALL OWNED F7 SCHEDULED <br />AUTOS ' IAUTOS <br />HIR ED AUTOS 1:1NON-OWNED <br />AUTOS <br />UMBRELLA LIAB I OCCUR <br />EXCESS L416 <br />WORKERS COMPENSATION <br />A IAND EMPLOYERS' LIABILITY <br />ANY PROPR ETOR PARTNERIEXECUTWE Y / N <br />OFFlCERIMEMBEREXCLUDED? ❑ NIA <br />(Mandatory In NH) <br />t( yes, describe under <br />MED EXP (Ary one person) f <br />PERSONAL 8 ADV INJURY S <br />_GENERAL AGGREGATE i <br />PRODUCTS COMP/OP AGG S <br />BODILY INJURY (Per Parton) 5 <br />BODILY INJURY (Per ecdderd) $ <br />Pt�OPERTV DAMA S <br />Lk-- acciden, t)_. <br />S <br />4CHOCCURRENCE IS <br />73GREGATE---- <br />133 06/04/11 06/04/12 E_LEACH ACCIDENT s 1,000,00( <br />F_ L DISEASE: EA EMPLOYEE S__ 1,000,00( <br />E. a DIBEASE . Poucv uMrr 1 s _ 1,000,00( <br />DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, A mons space Is required) <br />'roof of Coverage. <br />CERTIFICATE <br />Proof of Coverage <br />ACORD 25 (2010/05) <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THERE. NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY P ROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />©1988.2010 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />