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ACORD CERTIFIC OF LIABILITY INSURAIME FIDC 1 DATE <br /> Ofi/03 081 <br /> PRODUCER SERV1THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION <br /> George Petersen Ins Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> P, 0. Box 3539 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR <br /> 627 College Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Santa Rosa CA 95402 <br /> Phone: 707-525-4150 Fax:707-525-4175 INSURERS AFFORDING COVERAGE NAIC T! <br /> INSURED INSURER A: reSS Insurance CO a!RX <br /> INSURER B: <br /> Service Station Systems, Inc. INSURER C: <br /> 660 Quinn Avenue INSURER D: <br /> San Jose CA 95112 <br /> INSURER E: <br /> COVERAGES <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING <br /> ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br /> MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> Ri D' E IPOCC O <br /> � <br /> LTR NSR TYPE OF INSURANCE POLICY NUMBER POCVI:FFECT <br /> DATE MMmDW DATE 4MWDDIYYI LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE <br /> b <br /> COMMERCIAL GENERAL LIABILITY PREMISES Ea cccuranca) S <br /> CLAIMS MADE F7 OCCUR MED EXP(Any one par,w) 5 <br /> PERSONAL a ADV INJURY S <br /> GENERAL AGGREGATE S <br /> GEHL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGO 5 <br /> POLICY JE7 7 LOC <br /> AUTOMOBILE LIABILT' <br /> COMBINED SINGLE LIMIT S <br /> ANY AUTO (Ea accident) <br /> ALL OWNED AUTOS <br /> BODILY INJURY S <br /> SCHEDULED AUTOS (Per Person) <br /> HIRED AUTOS <br /> BODILY INJURY <br /> NON-OWNED AUTOS S <br /> (Per accident) <br /> PROPERTY DAMAGE S <br /> (Per accident) <br /> OARABE LIABILITY AUTO ONLY-EA ACCIDENT 5 <br /> ANY AUTO <br /> OTHER THAN EA ACL 5 <br /> AUTO ONLY: <br /> AGO 5 <br /> EXCESSAIMBRELLA LIABILITY <br /> EACH OCCURRENCE b <br /> OCCUR F-I CLAIMS MADE AGGREGATE S <br /> b <br /> DEDUC71BLE <br /> S <br /> RETENTION S <br /> 5 <br /> WORKERS COMPENSATION AND R EMPLOYERS' TORY LIMITS ER <br /> A LIABILITY 3310020636081 06 04 <br /> ANY PROPRIEiORIETORIPARTNER/EXECUTVE / /OB 06/04/09 EA-EACH ACCIDENT SIOOOOOO <br /> OFFICERIMEMBER EXCLUDED? EJ-DISEASE-EA EMPLOYEE $10 00000 <br /> tt yea,deeOlba under <br /> SPECIAL PROVISIONS balm EL DISEASE-POLICY LIMIT 5 1000°00 <br /> OTHER <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENTI SPECIAL PROVISIONS <br /> Re: License #485184 <br /> Evidence of Workers' Compensation Coverage. <br /> Ten Day Notice of Cancellation in the event of non-payment of premium. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYSWRITTEN <br /> NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO OD SO SHALL <br /> Contractors State License Boar IMPOSE NO OBLIGATION OR LIHBILTTY OF ANY KIND UPON THE INSURER,ITS AGENTS OR <br /> PO Box 26000 REPRESENTATIVES, <br /> Sacramento CA 95826 A RIUR ► e <br /> � <br /> ACORD 25(2001108) \vV\ ©ACORD CORPORATION 1988 <br />