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CERTIFAE OF LIABILITY INSURAICE OPID Cl DAM(MWDDJYYW) <br /> 06109/10 <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: It the certMeato holder is an ADDITIONAL INSURED,the po cy must be onclorsod. 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 endomement(s). <br /> PRODUCER NAME: <br /> George Petersen Ins Agency PHONE <br /> P. 0. Box 3539 ArC,No,ERtj _ _ I P.Nej_ <br /> 627 College Avenue ADDRESS: <br /> Santa Rosa CA 95402 CuarronEErRIoR: SERVI01 <br /> Phone:707-525-4150 Fax:707-525-4175 INSURER(S)AFFORDING COVERAGE NAIC0 <br /> INSURED INSURER A: Cypress IaGnrance Company <br /> S icQ Station Systems, Inc, INSURER BI <br /> 680 Quina Avenue <br /> San Jose CA 95112 INSURER C: <br /> INSURER D: i <br /> INSURER F <br /> INSURER P: <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TME INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT wn,RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED By PAID CIAIMS. <br /> LTR TYPE OF INSURANCE INSR y1/VD1 POLICY NUMBER (MWDOMlYYI (MWDDMYYY) LIWTS <br /> GENERAL LIABILITY EACH OCCURRENCE i <br /> COMMERCIAL GENERAL LIABILITY PREMISES�omrtErenuL E_ <br /> CIAhNS-MADE 71 OCCUR MED EXP(MY..person/ a <br /> PERSONAL$ADV INJURY I _ <br /> GENERAL AGGREGATE S <br /> GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG S T^� <br /> POLICY jEC`� f—I LOO <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S <br /> To ecddenl) <br /> ANY AUTO BODILY INJURY(Per Peraan) S —^ <br /> ALL OWNED AUTOS — -_ <br /> BODILY INJURY(Per�dem) $ <br /> SCHEDULEDAUTOS PROPENTYDAMAGE <br /> HIRED AUTOS (Pealden0 S <br /> er <br /> NON-OWNED AUTOS E <br /> I E <br /> OCCUR ! EACH OCCURRENCE E <br /> EXCESS LIMB CLAIMSMADE I AGGREGATE S <br /> DEDUCTIBLE <br /> RETENTION 4 ` E <br /> A WORKERS COMPENSATION 3310020636101 06/04/10 06/04/11 X <br /> AND EMPLOYERS'LIABILITY TORY LIMITS ER ' <br /> - <br /> ANY PROPRIETOR/PARTNERIEXECUTNErI EL EACH ACCIDENT 161000000 <br /> OFFICEWEMBER EXCLUDED? LJ IA <br /> (Mandatory In NH) E.L.DISEASE-FA EMPLOYEE $100 0 000 <br /> N yes,dmb.wt <br /> I DESCRIPTION OF OPERATIONS hate E.L.DISEASE-POLICY LIMIT I 51000ODO <br /> I <br /> I <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Aaaoh ACORD 101,Additional rtemuas Schsdele.11.Spam N nQWi ) <br /> Proof of coverage <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE 098CMEED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHOR MEED REPRESENTATIVE <br /> Proof of Coverage <br /> 0 1988-2009 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2009109) The ACORD name and logo are registered marks of ACORO <br />