Laserfiche WebLink
SERVSTA-CL SFRUSHOUR <br /> A�o�Ro CERTIFICATE OF LIABILITY INSURANCE 76/3/2014 <br /> MMIDD(YYYY) <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 /> PRODUCER CONTACT <br /> NAME: <br /> George Petersen Insurance Agency,Inc. Pn O°o Ext):(707)525-4150 A Na: 707 525-4175 <br /> P.O.Box 3539 ( ) <br /> Santa Rosa,CA 95402 E-MAIL <br /> ADDRESS: <br /> INSURER(S)AFFORDING COVERAGE MAIC N <br /> INSURER A:Insurance Company of the West 27847 <br /> INSURED INSURER B: <br /> Service Station Systems,Inc. INSURER C: <br /> 3224 Regional Parkway INSURER D: <br /> Santa Rosa,CA 95403 <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 /> INTRR TYPE OF INSURANCE POLICY NUMBER MM/LDCD//YYYY MY EFF MIC DYE LIMITS <br /> COMMERCIAL GENERAL LIABILITY <br /> EACH OCCURRENCE $ <br /> CLAIMS-MADE 0 OCCUR PREMISES Ea occurrence $ <br /> MED EXP(Any one person) $ <br /> PERSONAL&ADV INJURY $ <br /> GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ <br /> POLICY F7PRO ❑ <br /> JECT LOC PRODUCTS-COMP/OPAGG $ <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> Ea accident <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE <br /> HIRED AUTOS AUTOS Per accident $ <br /> S <br /> UMBRELLA LIAR Ld OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DEO I I RETENTION$ $ <br /> WORKERS COMPENSATION X PER 0TH- <br /> AND EMPLOYERS'LIABILITY STATUTE ER <br /> A ANY PROPRIETOR/PARTNER/EXECLMVE <br /> YIN <br /> N PL502130702 06/04/2014 06/04/2015 E.L.EACH ACCIDENT $ 1,000,00 <br /> OFFICE R/MEMBER EXCLUDED? ❑ N I A <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1,000,00 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If 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 /> C <br /> CoBox 26000 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Sacramento,CA 95826 <br /> AUTHORIZED(\R fEP�RES�ENTATIVE <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />