Laserfiche WebLink
• • DATE(MMIDDAYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE OPID Cl 06/09/10 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF fNFORMATION 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 /> IMP R A e ce tate o er an po ey mus[ en ora ,au Oct to <br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this Corti to does not confer rights to the <br /> certificate holder In lieu of such elldorsement(s). <br /> PRODUCER NAME. <br /> George Petersen Ins AgencyIAA:,00, (=,Nes__ <br /> -L <br /> P. O. Box 3539 <br /> 627 College Avenue ADK-- ----— --- <br /> Santa Rosa CA 95402 CUSTd1ER ID M: BERVI01 <br /> Phone:707-525-4150 Fax:707-525-4175 INSURER(S)AFFORDING COVERAGE Kwo <br /> INSURED INSURER A: CypFetils Insurance Company__ <br /> 9618"ie¢ Station Systems, Inc. POURER e: <br /> San Qux. Avenue INSURER C: <br /> San .Joao CA 95112 <br /> POURER D: <br /> INSURER E: <br /> PSURERP: <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IE 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WENCH THIS <br /> CERTIFICATE MAYBE 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 14AVE BEEN REDUCED BY PND CIAIMS. _ <br /> TYPE OF INSURANCE 00a�qq POE ICY NUMBER (NEND11 (MMmanm) LIMITS INSR V11101 _ <br /> GENERAL LIABILITY EACH OCCURRENCE S <br /> COMMERCIAL GENERAL LIABILITY I PREMISESPD MER S <br /> CLAIMS.MADE 71 OCCUR MED EXP(Any one sewn) f <br /> PERSONAL S ADV INJURY $ <br /> —_" GENERAL_AGGREGATE $ <br /> GENLAGGREGATEtIMITAPPUEEIS PER: PRODUCTS-COMWOP AGO S •--- <br /> POLICY �07 I LOC f <br /> Ed atltle <br /> AUTOMOBILE LIABILITY (Ed <br /> SINGLE LIMIT <br /> Ee M) <br /> ANYAUTO BODILY ODURY(PW slaw) a —�--- <br /> ALL OWNED AUTOS I BODILY INJURY(Pat wddW) --- <br /> SCHEDULEDAUTOS -PR ERTYDAMASF i <br /> HIRED AUTOS (Par IItt1dN11) <br /> i <br /> NON"ED AUTOS <br /> f <br /> UMBRELLALLAB OCCUR EACH OCCURRENCE i <br /> EXCESS LIAR CIAIMS.MADE f AGGREGATE f <br /> DEDUCTIBLE ( S �- <br /> RETENTION $ S <br /> A <br /> WORKERS COMPENSATION 310 3 D1 0E10a/30 0E/0a/11 TORY LIMITS ER <br /> AND AAPLOYERB'LIABILTTY YIN <br /> ANY PROPRIETORIPARTNEiuEXECUTNG-^-( E.L EACH ACCIDENT ESOOODOO <br /> OFFI:ERRMETASER EXCLUDED? u JA E.L.DISEASE-EA ENWLO $1000000 <br /> (Meadwary In NH) <br /> R yes,dmatx under E.L.DISEASE-POLICY LIMIT I$1000000 <br /> DESCRIPTION OF OPERATIONS Wm <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IANAsh ACORD 101,AddlBPnd RamMRe 3o118de1e,N more*Pa"M nRWrad) <br /> Proof of Coverage <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE Wml THE POLICY PROVISIONS. <br /> AUTNOROED REPRESENTATIVE <br /> Proof of Coverage. <br /> 0ISSS-20 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD <br />