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A�CORL7� CERTIFI TE OF LIABILITY INSUCE OPID C1 DATE(MM/DDIYYYY) 06/03/10 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL ,the po icy(ies)must be endorsed. If SUBROGATION IS WAIVED,sub)ect to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER George Petersen Ins Agency PHONE FAX- P. 0. Sox 353 9ac,No,Ext!.--_- - - ---- --- (A/C No); No): 627 College Avenue ADDRESS: Santa Rosa CA 95402 GUST_OME_RI_Q_it: SERVIOI Phone:707-525-4150 F'ax:7O7-525-4175 _ INSURER(S)APFORDINGCOVERAOE NAtcr INSURED INSURER A; Cypress Insu_ran_ce Compan'yService Station Station Systems, Inc. INSURERB: -- j 680 uinn Avenue -- San ose CA 95112 INSURER C INSURER D ENSURER E: -^--~---�--- - - I INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE I-ISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCP AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INUR; -. ---------- _ ___ _ EFF ICY LTR TYPE OF INSURANCE INSR,WVD POLICY NUMBER (MM/LDDr(YYY)?(MMIDDIYYYY) LIMITS GENERAL LIABILITY I EACH OCCURRENCE !$ -- fJWvfRL3E-TOAENTED _._.__..._.--_------.------- I COMMERCIAL GENERAL LIABILITY I I ' PREMISES(Ea occurrence) i S CLAIMS-MADEOCCUR ; MEQ EXP(Any one person) $ __Jr PERSONAL&ADV INJURY 1$ -------------- I----- ..`--- -- - - -- _� GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER' j PRODUCTS-COMPIOP AGG IS -- PRO- r--- POLICY t JECT LDC I$ AUTOMOBILE LIABILITY I COMBINED SINGLE LIMB i S (Ea accident) ANY AUTO ------ - ---- I BODILY INJURY(Per person) $ . ALL OWNED AUTOS i I -------------- --- BODILY INJURY(Per accident) S SCHEDULED AUTOS -- PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS i - -- $ UMBRELLA LIAB � EACH OCCURRENCE S EXCESSLUIB CLAIMS-MADE i r- -- - -----... - - -- -- - i AGGREGATE $ I DEDUCTIBLE I (-- ----------- ---a— ...._...---------- RETENTION $ 1$ A ' WORKERS COMPENSATION 1 3310 02 0 6361 01 •06/04/10 106/04/11 }� -' AND EMPLOYERS'LIABILITY YIN! i j -rTORY LIMITS __�ER �I ANY PROP RIETORIPARTNERIEXECUTIV I I E-L.EACH ACCIDENT $ 1000000 v IA OFFICER/MEMBER EXCLUDED —_--------- - ..-------. ----------------- --- (Mandatory lnNH) E.L,DISEASE-EAEMPLOYEEI $ 1000000 If yes.describe under DESCRIPTION OF OPERATIONS below j E.L,DISEASE-POLICY LIMIT j$ 10 0 OO O 0 I I I I i I i I I DESCRIPTION OF OPERATIONS 1 LOCATIONS i VEHICLES (Attach ACORD 101,Additional Remarks Schedule,H more space Is required) Proof of Coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOP,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Proof of Coverage @ 1988-26019 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD