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SERVSTA-CL SFRUSHOUI <br /> CERTIFICATE OF LIABILITY INSURANCE ffDATE(MM/DD/YYYY) <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.I06/31204 <br /> 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 be endorsed. If SUBROGATION IS WAIVED,subject to <br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER <br /> CONTACT <br /> George Petersen Insurance Agency,Inc. NAME: <br /> P.O.Box 3539 PHONE <br /> Santa Rosa,CA 95402 M�No Ext:(707)525-4150 FUC No:(707)525.4175 <br /> ADDRESS: <br /> INSURER(S)AFFORDING COVERAGE NAIC 0 <br /> INSURED INSURER A:Insurarlae Company of the West 27847 <br /> INSURER B: <br /> Service Station Systems,Inc. INSURER C <br /> 3224 Regional Parkway <br /> Santa Rosa,CA 95403 INSURER D <br /> INSURER E <br /> COVERAGESINSURER F <br /> CERTIFICATE 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 <br /> LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY P <br /> COMMERCIAL GENERAL LIABILITY MM/DDMM/DD!YYY-Y LIMITS <br /> CLAIMS-MADE E OCCUR EACH OCCURRENCE $ <br /> PREMISES Ea occurrence $ <br /> MED EXP(Any one person) $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL 8 ADV INJURY $ <br /> POLICY E PRO- GENERAL AGGREGATE $ <br /> JECT [:]LOC <br /> OTHER: <br /> PRODUCTS-COMP/OP AGG $ <br /> AUTOMOBILE LIABILITY $ <br /> COMBINED SINGLE LIMIT <br /> ANY AUTO Es accident $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per person) $ <br /> AUTOS AUTOS <br /> NON-OWNED BODILY INJURY(Per accident) $ <br /> HIRED AUTOS AUTOS PROPERTY DAMAGE <br /> Peraccident $ <br /> UMBRELLA LIAR OCCUR $ <br /> EXCESS LIAR CLAIMS-MADE EACH OCCURRENCE $ <br /> AGGREGATE $ <br /> DED RETENTION$ <br /> WORKERS COMPENSATION $ <br /> AND EMPLOYERS'LIABILITY X PER OTH- <br /> A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N PL502130702 STATUTE ER <br /> OFFICERIMEMBER EXCLUDED? ❑ N/A 06/04/2014 06/04/2015 E.L.EACH ACCIDENT $ 1,000,00 <br /> (Mandatory In NH) <br /> If yes,describe under E.L.DISEASE-EA EMPLOYE $ 1,000,00 <br /> DESCRIPTION OF OPERATIONS below <br /> E.L.DISEASE-POLICY LIMIT $ 1,000,00 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached N more space Is required) <br /> RE:License#485184 <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Contractor State License Board Workers Compensation Unit THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> PO Box 26000 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Sacramento,CA 95826 <br /> AUTHORIZED REPRESENTATIVE <br /> ACORD 25 2014/01 ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ( ) The ACORD name and logo are registered marks of ACORD <br />