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SERVS7A-01 HFAHY <br /> CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) <br /> 6/24/2013 <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 /> George Petersen Insurance Agency,Inc. NAME:PHONE <br /> P.O.Box 3539 AIC No Ext:(800)236-9046 4331 A/c No): (707)525.4175 <br /> Santa Rosa,CA 95402 E-MAIL <br /> ADDRESS: <br /> INSURER(S)AFFORDING COVERAGE NAIC N <br /> INSURER A:Insurance Company of the West <br /> INSURED _ <br /> 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 /> INSR <br /> LTR TYPE OF INSURANCE POLICY NUMBER POLI Y EFF POLICY EXP <br /> MM/DDlYYYYI <br /> 1MM1DDrfYYYI LIMITS <br /> GENERAL LIABILITY <br /> Ma <br /> ACH OCCURRENCE $ <br /> COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ <br /> CLAIMS-MADE D OCCUR MED EXP(Any one person) $ <br /> PERSONAL d ADV INJURY $ <br /> GENERAL AGGREGATE $ <br /> GENT AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ <br /> POLICY PRO-JECT LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> Ea accident <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED <br /> AUTOS AUTOS BODILY INJURY(Per accident) $ <br /> NON-OWNED PROPERTY DAMAGE $ <br /> HIRED AUTOS AUTOS Per accident <br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB HCLAIMS-MADE <br /> AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION WC STATUOTH- <br /> AND EMPLOYERS'LIABILITY YIN x TDRY <br /> LIMIT- ER <br /> A ANY PROPRIETOR/PARTNER/EXECUTIVEPL502130701 6/4/2013 6/4/2014 E.L.EACH ACCIDENT <br /> OFFICERIMEMBEREXCLUDED? ❑ NIA $ 1,000,00 <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1,000,00 <br /> H yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,nn <br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,H 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 /> ©1988-2010 ACORD CORPORATION, All rights reserved. <br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD <br />