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�� • OP ID:C1 <br /> ,4co�rr�' CERTIFICATE OF LIABILITY INSURANCE DAT101041I0 <br /> ofoalo <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(iss) 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 707.525-4150T <br /> ACT <br /> NAME: <br /> George Petersen Ins Agency 707-525.4175 PHONE <br /> fNo. <br /> P. O. Box 3539 L —-- __-- <br /> 627 College Avenue AA Maas. — _---- -- ---- <br /> Santa Rosa,CA 96402 USTOMERMM LEM•1 <br /> Douglas,-Djlley INSURE IIAFFORDWO COVERAGE NAICS <br /> INSURED Able Maintenance,Inc. INSURER A:Insurance Company Of the West <br /> 3224 Regional Parkway INSURER B: _ <br /> Santa Rosa,CA 96403 -'� <br /> INSURER C: <br /> a1WRER D: <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 OROTHERDOCUMENT 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 /> Basal TYPE OF INSURANCEPOLICY NUMBER ADDI BUBOIPOLICY a" I MYmO YAV TpIPJun imm LIMITS <br /> OENGRAL LIABILITY EACHOCCURRENCE a <br /> COMMERCIAL GENERAL LIABILITY PREMI SFS Ea oc umenoe S <br /> CLAMS/Aaoc OCCUR MED FxP(Myons person i <br /> PERSONAL4ADVINJURY _--- <br /> GENERAL AGGREGATE a <br /> GENL AGGREGATE LMR APPLIES PER: PRODUCTS-COMPIOPAGG S <br /> POLICYF1PRO- LOC _ f <br /> JECT f7AUTOMOBILE LIABILITY <br /> SINGLE LIMIT S <br /> (Es saMan) <br /> ANY AUTO 90DIlY INJURY(PY parson) S <br /> ALLOWNEDAUTOS BODILY WJURY(PrWdd" S <br /> SCHEDULED AUTOS <br /> PROPFRTYDAMAOE a <br /> HIRED AUTOS IPeramdYlq <br /> NON-OWNEDAUTOS '! S <br /> UMBRELLA LMB OCCUR EACH OCCURRENCE S <br /> EXCIUM LMB CLAIMS-MADE1 AGGREGATE <br /> DEDUCTIBLE ,- <br /> RETENTION f a <br /> WORKERS COMPENSATIONX n5 WCSTATU- CTH- <br /> ANDEMPLOYERS'LIOUNUTY ORYL)M <br /> A ANY PROPRIETORFARTNER/EXECUTNE YIN PL500060302 10/01110 10101111 EL EACH ACCIDENT a 1,000,00 <br /> OFFICERMIEMBER EXCLUDED? E� NIA <br /> (Mandatory In NHl E.L.DISEASE-EA EMPLOYE E 1,DOO,00 <br /> irres oesaibeunder <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000100 <br /> OESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ABach ACORD 101,Addalonel Remarks Schedule,H mom space Y required) <br /> RE:License 0312844 <br /> Proof of Coverage <br /> CERTIFICATE HOLDER CANCELLATION <br /> CONDOMI <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Contractors State License ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Board-Workers Comp Unit AUTHORREOREPRESENTATNE <br /> PO Box 26000 <br /> Sacramento, CA 95828 <br /> I <br /> ®1988-2009 ACORD CORPORATION. All rights reserved. <br /> ACORD 26(200BID9) The ACORD name and logo are registered marks of ACORD <br />