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-1 OP 10;C1 <br /> CERTIFICATE 4F LIABILITY INSURANCE DA10104110 <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 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 /> PRODUCERCONTACT <br /> 707-525-4150 NAME: <br /> PHON <br /> George Petersen Ins Agency 707-525-4175 WC,N,Ext) <br /> P. O. Box 3539 ADDRESS: <br /> 627 College Avenue _.-----_---------------------- --------..-------- <br /> Santa Rosa,CA 95402 CUSTOMER ID f:ABLEMA <br /> INSURER(S) AFFORDING COVERAGE MAIC# <br /> INSURED Ale Maintenance,Inc. INSURER A:insurance Company of the West <br /> 3224 Regional Parkway INSURER 8 <br /> Santa Rosa,CA 95403 -- <br /> wsuRER c <br /> INSURER D <br /> INSURER E:MAI FDFR 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 /> R T TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMI Df EXP <br /> LTLIMITS <br /> GENERAL LIABILITY EACH OCCURRENCEDAMAGS __ <br /> _ COMMERCIAL GENERAL LIABILITY I PREMISES $ <br /> CLAIMS-MADE -1 OCCUR I MED EXP(Any one person) <br /> �$_Y______�_-. <br /> PERSONAL 8 ADV INJURY S <br /> �.. GENERAL AGGREGATE S <br /> GEN'L AGGREGATE LIMITAPPU -+ES PER: I I PRODU'T <br /> CTS_COMPlOP AGG <br /> 11 <br /> POLICY PRO• LOC � —^ <br /> AUTOMOBILE LIABILITY i COMBINED SINGLE LIMIT $ <br /> (Ea accident) <br /> ANY AUTO I BODILY INJURY(Per person) $ <br /> {ALL OWNED AUTOS <br /> BODILY INJURY(Per accident) $ <br /> SCHEDULED AUTOS <br /> i I PROPERTY DAMAGE $ <br /> —j HIRED AUTOS I (Peeracadenl) <br /> NON-OWNEDAUTOS I I _ __— _-� <br /> S <br /> I--�UMBRELLA LIAB I J OCCUR I EACH OCCURRENCE ($ <br /> h1 — ---— — — -. -- - <br /> EXCESS LIAB I CLAIMS-MAD� li i AGGREGATE <br /> _ f DEDUCTIBLE <br /> RETENTION _�-._..__._�_..__.__._____j.b_ <br /> WORKERS COMPENSATION k 1 ' X I TNQ jY1,A{u rT§_L-1-Fe-R— <br /> AND <br /> EMPLOYERS'LUBILITY YIN 1 .Ihi1r <br /> A I ANY PROPRIETOR/PARTNERIEXECUTIVE l IWPL500060302 I 10!01110 10/01/11 {EL EACH ACCIDENT $ 1,000_,00 <br /> OFFICERIMEMBER EXCLUDED? ❑i N I A I JI1,OU�,UU <br /> (Mandatory In NH) I E.L.DISEASE-EA EMPLOYE °$ <br /> I IF yes,describe under <br /> DESCRIPTION OF OPERATIONS belowJ E.L.DISEASE-POLICY LIMIT i$ 1,000,00 <br /> I i <br /> � � I <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,Ir more space is required) <br /> RE:License#312844 <br /> Proof of Coverage <br /> CERTIFICATE HOLDER CANCELLATION <br /> CONDOM1 <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Contractors State License <br /> Board-Workers Comp Unit AUTHORIZED REPRESENTATIVE <br /> PO Boxto <br /> Sacramento,CA 95528 <br /> I <br /> C 1988-2009 ACORD CORPORATION. All rights reserved. <br /> ACORD 26(2009709) The ACORD name and logo are registered marks of ACORD <br />