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SERVI01 OP ID: C1 <br /> A�oRo CERTIFICATE bF LIABILITY INSURANCE OAT061031 1 <br /> 06!03!11 <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(les)must be endorsed. If SUBROGATION IS WAIVED,subject to <br /> the terns 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 707.5254150 co TA T <br /> George Petersen Ins Agency NAME: <br /> P.O.Box 3539 7075251175 (HON o fui,NO): <br /> 627 College Avenue E-MAINL �1 "— <br /> Santa Rosa CA 96402 ADDRESS: -_- <br /> Douglas Diliey <br /> INbURERL3t�gFFOROINO COVERAGE NAICR <br /> ___ _ INSURERA:Travelera Pro Cos ofAmerlCa __ 25674 <br /> INSURED Service Station Systems,in—c.— INSURERS: <br /> 3224 Regional Parkway -- — ---- <br /> Santa Rosa,CA 95403 INSURER C: _ <br /> WSVRER J,- <br /> INSURER E: _ <br /> I U ERF: <br /> COVERAGES CERTIFICATE NUMBER. REVISION NUMBER: <br /> 'HISS 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 P 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 TYPE OF INSURANCE Aebl -- 0 EFF LIOYEXP �— <br /> POLICYNI BER MWD MWD LIMITS <br /> GENERAL I MAILm <br /> - EACH OCCURRENCE S <br /> *EXCLUDED? <br /> OMMERCIALGENERALLMegm REMISES Ee eceurrerRP f _ <br /> ,CLAUAS4AADE ❑OCCUR IVIED---_ PERSONALSADVINJURY S <br /> -- GENERALAGGREGAM SAGGREGATE LIMIT APPLIES PER. PRODUCTS-COMPIOP AGG 6 <br /> OLICY PRO LOC S <br /> op. <br /> OBILE LIABILmCORmegD l NGLE LIMIT <br /> Y AUTOBODILY INJURY IPer parson) S <br /> L OWNED SCHEDULEDTOS AUTO$ gO01LY INJURY(Per attJdeN) S <br /> IRED AUTOS NONOWNED PERT`%AUTOS if <br /> SRELLA LMB OCCURE/ICH OCCURRENCE S <br /> CESS LIAR CLAIMS44ADE GGREGATED RETENTIONSRS COMPENSATION WC STAN OTHPLOYERS'LIABILITY ANY R/MEM�EXCLUDED ECLmVE Y/❑N NIA 88054F2f33 08104/11 O6I04/72 E-L EACH ACCIDENT S 1,000,00aaxwato, UndE-L DISEASE-EA EMPLOYEE s 1,000,00aamwa order PTION Of OPERATION$bNca <br /> DISEASE-POLICY LIMB I S 1,000,0 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(leach ADD=101,AdElNonal RemaMs SchNole,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 /> THE EXPIRATION DATE THEREGF, NOTICE WILL BE DELIVERED IN <br /> Proof of Coverage ACCORDANCE WITH THE POLICY P ROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> 01988-2010 ACORD CORPORATION. Ali rights reserved. <br /> ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD <br />