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OP ID:C1 <br /> ,d►`oRa CERTIFICATE OF LIABILITY INSURANCE DA 10104/10 <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(in) 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 endorsemen s . <br /> PRODUCER 707-625-4150 CONACT <br /> NAME: <br /> George Petersen Ins Agency 707-525-4175 HON .EaE <br /> P. O. Box 3539 -'—_--'— <br /> 627 College Avenue ADDRESS:PRODUCER <br /> ----_--- <br /> Santa Rosa,CA 95402 ° MER e'BLEM'f — <br /> nmrglian n lipyIN B APPWtDING COVERAGE WUDa <br /> MSURED A61e Maintenance, Inc. INSURER A;Insurance Company of the West _ <br /> 3224 Regional Parkway INSURER e: <br /> Santa Rosa, CA 95403 <br /> wwaEa c <br /> INSURER <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 /> INDICATE, 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.ADDI <br /> e/BR ME OF WBURANCE no son POLICY NUMaERI YIDD� MAV f CYEXP LNMB <br /> GENERALLMBRnY EACHOCCURRENCE a _ <br /> Comm IL GENERAL LWILITY PREMISES Es S <br /> CLAPA"ADE O OCCUR i MEDFXPPLAryampwwn S _ <br /> PERSONAL S ADV INJURY( f <br /> GENERAL AGGREGATE a ------- <br /> GEN'L AGGREGATE LMR APPLIES PER: PRODUCTS-COMPIOP AGG S <br /> POUCY 1PRO LOO -- _ _S <br /> AUTOMOBILE LIABILITY I COMBINED SINGLE!!Alli a <br /> 'EAeo9EamJ <br /> ANY AUTO BODILY INJURY(PM person) S <br /> ALL OWNED AUTOS -- <br /> I SCHEDULED AUTo3 PROILYPERTY <br /> TYDA (Pere�dMR) a <br /> PROPERTY OAMA(1E a <br /> HIREC AUTOS <br /> NON-0WNEDAUTOS —__ a—^ <br /> s — <br /> UMBRELLALUIB I �c(ra EACH OCCURRENCE SCLAJMS _ <br /> EXCESS UAB OccuRJAADE AGGREGATE _ a —...—._- <br /> _ DEDUCTIBLE <br /> RETENTION a <br /> WORKERS COMPENSATION x WC STATU- OTH- <br /> AND EMPLOYERS'LIABILITY ORY � <br /> A ANY PROPRIETORIPARTNERIEXEOUTIVE YIN <br /> NIA L500060302 10/01/10 10/0111 EL EACH ACCIDENT a 1,00voro0 <br /> OFFICERNEMBER EXCLUDED? <br /> (Mentlebry M NH) I E.L.DISEASE-FA EMPLOYE S 1,1)00,000 <br /> I(yea RIPTI EM OF O <br /> DESCRIPTION OF OPERATIONS OeIow E.L.DISEASE-POLICY LIMIT S 1,000.0 <br /> DESCRIPTION OF OPERAnONS I LOCATIONS I VEHICLES (AeAcE ACORD 101,Atleieonal Remarks BohsEUle,N more spam V nquBetl) <br /> RE:License#312844 <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 AUTNOPREO REPRESENTATIVE <br /> PO Box26000 <br /> Sacramento,CA 95828 <br /> ®1988-2009 ACORD CORPORATION. All rights reserved. <br /> ACORD 26(2009109) The ACORD name and logo are registered marks of ACORD <br />