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SERVSTA-CL NWINTEF <br /> A�ORO CER i IFICATE OF LIABILITY INSURANCE Dt181201 <br /> M/DD/YYYY) <br /> 5 <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. PHONE 707 525-4150 FAX 707 525-4175 <br /> P.O.Box 3539 A/c No Ext:( ) (A/c,N. ( ) <br /> Santa Rosa,CA 95402 E-MAILADDRESS:info@gpins.com <br /> INSURERS AFFORDING COVERAGE NAIC S <br /> INSURER A:Insurance Company of the West 27847 <br /> INSURED INSURER 8: <br /> Service Station Systems,Inc. INSURER C: <br /> 3224 Regional Parkway INSURER D: <br /> Santa Rosa,CA 95403 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 /> ILTR TYPE OF INSURANCE POLICY EFF POLICY EXP <br /> LTR INSD WVD POLICY NUMBER MM/DDIYYYY MM/DD/YYYY LIMITS <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ <br /> DAMAGE ToRENIED <br /> CLAIMS-MADE D OCCUR PREMISES Ea occurrence $ <br /> MED EXP(Any one person) $ <br /> PERSONAL 8 ADV INJURY $ <br /> GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ <br /> PRO- <br /> POLICY JECT 1-1 LOC PRODUCTS-COMP/OP AGG $ <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY J EO BINEDISINGLE LIMIT bL $ <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per a <br /> ccident) <br /> $AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE <br /> AUTOS VRON � $HIRED AUTOS Per accident <br /> UMBRELLA LIAB OC $CUR <br /> EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE <br /> ENTION <br /> DED RET $ $ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY X STATUTE ER <br /> A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WPL502130703 06/04/2015 06/04/2016 E.L.EACH ACCIDENT $ 1,000,000 <br /> OFFICER/MEMBEREXCLUDED? ❑ N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 <br /> l yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) <br /> 'Proof of Coverage' <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Insured's Copy THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />