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B&TSERV-02 PATRA03 <br /> ACORO CERTIFICATE OF LIABILITY INSURANCE <br /> [::.AOTE(MM/DDfYYYY) <br /> 8/16/2017 <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(ies)must have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER License#0305584 CONTACT Norma Jean Perez <br /> Morris&Garritano Insurance Agency,Inc. Pvc°NN ,($05)543-6887 368 ac,No:(805)543-3064 <br /> PO Drawer 1189 <br /> San Luis Obispo,CA 93406 E I .nperez@morrisgarritano.com <br /> INSURERS AFFORDING COVERAGE NAIC# <br /> INSURER A:Depositors Insurance Company 42587 <br /> INSURED INSURER B:State Compensation Insurance Fund of California 35076 <br /> KC Partners Corp dba: B&T Service Station Contractors INSURERC: <br /> 630 S Frontage Road INSURER D: <br /> Nipomo,CA 93444 <br /> INSURER E <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 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. <br /> INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br /> L <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ <br /> CLAIMS-MADE ❑OCCUR DAMAGE TO RENTED <br /> PREMISES(E.occurrence) $ <br /> MED EXP(Any oneperson) $ <br /> PERSONAL&ADV INJURY <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE <br /> POLICY❑JECT LOC PRODUCTS-COMP/OP AGG $ <br /> OTHER: <br /> A AUTOMOBILE LIABILITY <br /> COMBINED tSINGLE LIMIT $ 1,000,000 <br /> X ANY AUTO ACP7802727977 08/15/2017 08/15/2018 BODILY INJURY Perperson) $ <br /> OWNED SCHEDULED <br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $ <br /> HIRED NON-OWNED PPeOracaiRdent AMAGE $ <br /> AUTOS ONLY AUTOS ONLY <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE <br /> DED 1 1 RETENTION$ <br /> B WORKERS COMPENSATION X PER OTH- <br /> AND EMPLOYERS'LIABILITY TA T _ <br /> ANY PROPRIETOR/PARTNER/EXECUTIVEY/N 90685282017 08/15/2017 08/15/2018 E.L.EACH ACCIDENT 1,000,()00 <br /> OFFICER/MEMBER EXCLUDED? N/A 1,000,600 <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYE <br /> Ifs describe under 1,000,000 <br /> DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is qu <br /> Re:Proof of Insurance. Wm "ED <br /> ar� <br /> JUN 2 2 2018 <br /> ENVIRONMENTAL <br /> CERTIFICATE HOLDER CANCELLATION "AFITMENT <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Issued for Information Only THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Y ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> I A <br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />