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DATE(MM/DD/YYYV) <br /> Itc9R CERTIFICATE OF LIABILITY INSURANCE 6/29/2017 <br /> THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELYAM END,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 /> REPRESENTATIVEDR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT:If the certHicateholder is an ADDITIONALINSURED,the policy(ies}nust be endorsed.If SUBROGATIONS WAIVED,subjectto <br /> the terms and conditionsof the policyFertainpoliciesmayrequirmn endorsement.A statemenlon thiscertificatedoes not conferrights to the <br /> certHicateholder in lieu of such endorsement(s). <br /> PRODUCER CONTACT <br /> NAME <br /> DINA ATHEY <br /> ISU INS SERV - BC ENV BROKERAGE PHONE FAX <br /> AIC ,x.No. (916)939-1080 A/C.Nu: (916)939-1085 <br /> 1037 Suncast Ln Ste 103 E+ L <br /> ADDRESS: <br /> El Dorado Hills, CA 95762 INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURERA. ADMIRAL INSURANCE COMPANY 24856 <br /> INSURED KC PARTNERS CORP. , DBA: BST INSURER <br /> SERVICE STATION CONTRACTORS, INC. INSURERC. <br /> 630 S. FRONTAGE ROAD INSURERD <br /> NIPOMO, CA 93444 INSURERS <br /> INSURER F <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED 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 /> EXCLUSIONSANDCONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BYPAID CLAIMS. <br /> a POLICY EFF POLICY FXP <br /> TYPE OF INSURANCE POLICY NUMBER MM/DO/VYYY MMIDD/YVYY LIMITS <br /> X COMMERCULLGENERAL LIABILITYEACH OCCURRENCE b 1 000 000 <br /> RENT ED <br /> /+CWTMS�MADE , A����1 OCCUR PREMISES Ea occurrence E <br /> X X,C, IINC. MED EXP(Anyone p—) E 5 000 <br /> FSI-ECC-16027-04 6/23/17 6/23/16 <br /> A PERSONAL BADV INJURY E 1,000,000 <br /> GEN'L AGGREGATE�LIMIT APPLIES PER^: GENERAL AGGREGATE E 2,000,000 <br /> FIR <br /> POLICY `�!JEo 11��I LOC PRODUCTS-CCMP/OPAGG E 2,000 000 <br /> OTHER E <br /> AUTOMOBILE LIABILITY CEOa E 1,000/000M <br /> ANYAUTO BODILYINJURY(Perpe,son) b <br /> ALL OWNED SCHEDULED FEI-ECC-16027-04 06/23/17 06/23/18 <br /> A BODILY INJURY(Parawidant) b <br /> A TOS <br /> X HIRED AUTOS X AON—ED INC. IN GL (PerOa PER <br /> Yt DAMAGE <br /> UTOSE <br /> E <br /> X UMBRELLA LIAR X OCCUR EACH OCCURRENCE E 5,000,000 <br /> A EXCESS LIAR - CMS-MADE �I-EXS-16028-04 06/23/17 06/23/18 AGGREGATE E 5,000,000 <br /> OVER PRIM,AUTO,WC <br /> OFD I I RETENTION E E <br /> WORKERS COMPENSATION PER I+ <br /> VIN OT <br /> AND EMPLOYERS'LIABILITY STATUTE ER <br /> ,wr a r.11TawaarrrvuEe cuTry �NIA <br /> FE.ACHACCIDENT E <br /> MPLOYEE E <br /> Ifyes,dsait,eunderDESCRIPTION OFOPERATIONS below Y LIMIT E <br /> A CONT. POLL. LIAB. FEI-ECC-16027-04 06/23/17 06/23/18 00 OCCURRENCE <br /> PROF LIAB (CLMS-MD) PL RETRO 7/15/05 AGGREGATE <br /> ' .e <br /> DESCRIPTION OF OPERATIONS/LOCATIONSI VEHICLES(ACORO 101,AddNanal Remarks Schetlule.may be alGd,ad i(more space is,eR.red) <br /> JUN 2 2 2018 <br /> ENVIRONMENTAL HEALTH <br /> DEP <br /> CERTIFICATE HOLDER CANCELLATION <br /> -FOR INFORMATIONAL PURPOSES— SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE VLILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POUCY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> M <br /> o3+jJ Cr�04.4 <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD25(2014/01) The ACORD name and logo are registered marks of ACORD <br />