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- "- - .. - -- - - '' .— • • L- %.+I L-11-%u1LI I 1 III-Q3j.fOP ID C1 UATE(MMtODIYYYy) <br />PRODUCER SERVI01 06/23 21/ O8 <br />George Petersen Ins Agency TH78.CERTIFICATf 7 UED A5 A MATTER SOF INFORMATION <br />P. 0. Box 3539 ONLY :AND. CONFERs.Iv0.RIGHTS UPON THE:OERTIFJCATE <br />HOL•0ER:3+11S:CEfMFICATE D OES NOT AMENDS EXTEND OR <br />621 College Avenue ALTER'-THE:COVERAGElAFFORDEO-'BY THE P06CIES'BELOW. <br />Santa Rosa CA 95402 <br />Phone:7D7-525-4150 Fax:707-525-4175 INSURERS AFFORDING COVERAGE <br />INSURED NAIC # <br />INSURER A: eaa. Insurance Car=--- <br />Service Station Systems, Inc. <br />680 QQuuinn Avenue <br />wSIDRJ=RI: <br />San ,Tose CA 95112 <br />INauIeERID:.. <br />COVERAGES <br />INSUM.IE: <br />THE POLICIES OF INSURANCE LISTED BELow RAVE BEEN ISSUEO TO THE INSURED NAMED ASM-FOR4WIPOL4C'i�IPFRIODINDICATED-NDTWRMTANDING <br />ANY REOUREMENT, OR <br />TERM CONDIT40N OF ANY CONTRACT DR DTHER.00CUMENT WITH RESPECT TO;WHIOHTENS+GERrWIC$kTE.MAY SEOSSUEDnR <br />MAY PERTAIN; THE?NSURANCE <br />AFFORDED aY THE POLICIES; DESCRISEOMEREIN IS <br />SUBJECT TO ALL THVTERMS XCL'USIONS <br />POLICIES. AGGREGATE'LIAITSSHOWNMAYHAVE BEEN REDUCED BY PAIDDLAWS. <br />'AND CONDITIONSCF SUCH <br />RiSw <br />LTR NSR TYPE OF INSURANCE POLICY NUMBER <br />D� /pO�A�Tti <br />GENERAL,L ABILITY <br />Opyy LIMITS <br />COMMERCIAL GENERAL LUABILOY <br />CAC�11 C6y S <br />CLAIMS MADE F7 OCCUR <br />P foanC— S <br />M416RXP,�AIIYo11/�+«+1 S <br />At1V1917RY S <br />GENL AGGREGATE LIMIT'APPLIES PER <br />UEN�LlL010OF1ECfFTE S <br />POLICY JET LOC <br />t=AU.CTi--COMPIOPAGG S <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />COMBINED SINGLE LIMIT <br />(EI maiden.) I <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />BODILY INJURY <br />(Per person) S <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />BODILY INJURY <br />(PIT IrcldvY) S <br />PROPERTY DAMAGE <br />(Per spudenl) t <br />OARAOE LIABILITY <br />ANY AUTO <br />AUTO ONLY • EA ACCIDENT 3 <br />HOTHER <br />THAN EA ACC S <br />EXCESSJVMBREIu LIABILITY <br />AUTO ONLY: AGG S <br />OCCUR � CLAIMS MADE <br />EACH DCCURRENCE 3 <br />AGGREGATE <br />DEDUCTIBLE <br />RETENITION 3 <br />3 <br />WORKERS COLi"NSATION AND <br />S <br />EMPUOYERE'4SA90!T <br />A JVfTVR3310020636081 <br />8 T I R <br />06/04/08 06/04/09 E.LEWCDERRR��X <br />D <br />T ;S100 O00 <br />E.L.QAASE: EA YE :S 1Do <br />S below <br />OTHER <br />,ECLALM <br />EL,T]6EI. E,4'P0OICY.0 MIT? S s10001a.0D <br />DESCRIPTION OPiOPERATKDNII LOCATIONS 1 VEHICLES I EXCLUSIONS AODED8YjND5WA1eI1NTYSPEM"ROVISION3- <br />Re: License #485184 <br />Evidence of Workers Compensation Coverage. <br />Ten Day Notice of Cancellation in the event <br />of non-payment of- premium. <br />CERTIFICATE HOLDER <br />CANE ELLATdON <br />SHOULD.ANYAOF-THSAHOVE DESCRIBED}OLICIES It CANCELt#D9EFOREMZUPIRAT10N <br />DATETHERIOF;THE•IMSUINO INS URERIWILLJ:NOGAVOR TONIAIL 30* - <br />DAY1 WKFMN <br />N0TICE70THE OEM r CATE HOLDBR NAMED TO THE LETT, BUT FAILURE TO DO 10 SHALL <br />Contractors State License Boar <br />IMP01111NOADR DATION OkLIABILI Y DF ANY KIND UPON THE INSURER, ITS AGENTI OR <br />PO Box 26000 <br />REPNItBMMATIVEB. <br />Sacramento CA 95826 <br />JA SM TIVE <br />ACORD 26 (2001108) OACORD CORPORATION 1988 <br />