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MOO <br /> L—� CERTIFICATE OF LIABILITY INSURANCE SERVSTA-CL Dwnrrs <br /> DATE(NMAIOryyyy) <br /> THIS CERTIFICATE IS ISSUED AS TI 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 HOLDER. <br /> 6/2312016 <br /> BELOW. THIS CERTIFICATE E INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the ons of thce'e hoitler is an ADDITIONAL INSURED,the Policy(les)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 entlorsement(s). <br /> PRODUCER <br /> Geo! a Petersen Insurance Agency,Inc. CONTACT <br /> P.D.BOA 3539 NAME: <br /> ANOMIE Exl:(707)6 25-4160 FAX <br /> Santa Rosa,CA 95402 E-MAIL AID Ne: (707)525-4176 <br /> aooREss:Info pins.com <br /> _ INSURERIS AFFORDING COVERAGE <br /> INSURED — -- INSURERA:IDSDFBOCe COT i O MAIC# <br /> INSURER 8: 27847 <br /> Service Station Systems,Inc. <br /> 3224 Regional Parkway INSURER c: <br /> Santa Rosa,CA 95403 INSURER D: r <br /> INSURER E: v <br /> COVERAGESINSURER F: <br /> CERTIFICATE NUMBER: - I <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSU EDV <br /> INDICATED. MAYNOTBeHS SUED O ANY REQUIREMENT,IN, THE <br /> TERM AN CONDITION OF ANV CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BV THE POLICIES DESCRIBED HEREIN IS SUBJEOC PELT TO WH HRMS, <br /> INSR EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAV HAVE BEEN REDUCED BY PAID CLAIMS. <br /> LTR TYPE OF INSURANCE DLICY EFF P LI Y <br /> COMMERCIAL GENEIUIL LIABILnY POLICY NUMBER MM DDIyyYY MM/ODn-YYy <br /> UNITS CVJMS-MADE El OCCUR EACH OCCURRENCE S <br /> PREMISES Eacco rsnce f <br /> MED EXP(My one perbn S <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY $ <br /> POLICY ECOT r-�LOC GENERAL AGGREGATE S <br /> OTHER: PRODUCTS-COMPIOP AGO S <br /> AUTOMOBILE UASILITY $ <br /> ANY AUTO CasrBoNEDSINGL LIMIdew $ <br /> AALL ED SCHEDULED BODILY INJURY(Per mam) S <br /> AUTOS <br /> HIRED AUTOS NON-OWNED BODILY INJURY(Per acrldenp S <br /> AUTOS ParOPERTYecoomMAGE S <br /> Lee EL LIAR OCCUR S <br /> EXCESSLIAB C(AIMSMADE EACHOCOURRENCE a <br /> DEO RETENTIONS AGGREGATE S <br /> WORKERS COMPENSATION S <br /> AND EMPLOYERS'LIABUTY <br /> A ANY PROPRIETOR/PARTNER,E)ECUNE YIN L6112130704 X STATUTE ER <br /> OFFICER/MEMSER OCCLUDED? ❑ NIA 0$/114/2015 06/04/2017 <br /> (Mandatory In NH) E.L.EACH ACCIDENT = 1,00,00 <br /> X s, e mom <br /> DRIPTIOIMION OFF OPERATIONS beLTw E.L DISEASE-EA EMPLOYE S 1,000, <br /> ESCO <br /> E.L.DISEASE-POLICY LIMIT $ 1,000,00 <br /> DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES (ACORD1a1,AUditleml Remarks SCMdule,may a snacked H mom space Is inquired) <br /> RE:License#485184 <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> ECState License Board Workers Compensation Unit THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> DO ACCORDANCE WITH THE POLICY PROVISIONS. <br /> , CA 95826 <br /> AUTH�OR�IZED\RE^PRE�SENTATNE <br /> �`• V U _ <br /> ACORD 25(2014/01) 8 <br /> 2 <br /> The ACORD name and logo are registered marks of ACORD ACORD CORPORATION. All rights reserved. <br />