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SERVSTA-01 <br /> CERTIFICATE OF LIABILITY INSURANCEDATE(NN <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDE <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE PI <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),RUTH( <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: N the certificate holder Is an ADDITIONAL INSURED,the polky(ks)must be endorsed. If SUBROGATION IS WAIVED,Sul <br /> the terms and r In <br /> oft policy,certain policies may require an endorsement. A statement on this certificate does not confer right <br /> certificate holder In Ifeu of cuch endorcement(s). <br /> PRODU="nn <br /> Georgncy,Inc. REACT <br /> P.O.BPHONE (B00 236-9046 A <br /> Santa A L A/C Ne (888)579, <br /> ADDRESS: <br /> MSUIRER(b AFFORDING COVERAGE <br /> IN <br /> INSURER A:ICW Group <br /> INSURER a: <br /> Service Station Systems,Inc. INSURER C: <br /> 6SO Quinn Ave <br /> San Jose,CA 95112 INSURER 0: <br /> INSURER 15: <br /> COVERAGES CERTIFICATE NUMBER: MsuRERF; <br /> N NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDREVIA OVE FOR THE POLICY PE <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TEF <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> LTR TYPE OF INSURANCE <br /> GENERAL LIABILITY POLICY NUMBER M/DDM YY <br /> MN/DDM'YY LIMITS <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S <br /> CLAIMS-MADE OCCUR PREMISES Ea occurrence S <br /> MED EXP(Any one person) j <br /> PERSONAL&ADV INJURY S <br /> GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE j <br /> POLICY L7 <br /> PRO- LOC PRODUCTS-COMP/OP AGG $ <br /> AUTOMOBILE LIABILITY $ <br /> M I I LE LIMIT <br /> ANYAUTO E.scddent <br /> ALL OWNED SCHEDULED BODILY INJURY(Per person) s <br /> AUTOS AUTOS <br /> HIRED AUTOS NON-OWNED BODILYINJURV(Peraccident) S <br /> AUTOS PROPERTY DAMAGEPer accident S <br /> UMBRELLA LIAB OCCUR S <br /> EXCESS LIAR CLAIMS-MADE EACH OCCURRENCE S <br /> DED RETENTIONS AGGREGATE S <br /> WORKERS COMPENSATION <br /> AND EMPLOYERS'LIABILITY X WC STATU- 0TH- S <br /> A ANY PROPRIETOR/PARTNERIEXECUTIVE YIN PL502130700 <br /> (Mandatory <br /> in NER EXCLUDED? a N/A 6/4/2012 6/4/2013 E.L.EACH ACCIDENT <br /> Ifendatory eNnd f 1,000, <br /> K describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-EA EMPLOYE $ 1,000,1 <br /> E.L.DISEASE-POLICY LIMIT $ 1,000,1 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD101,Additional Remarks Schedule,H <br /> more space is required) <br /> Proof of coverage <br /> CERTIFICATE HOLDER <br /> CANCELLATION <br /> SHO <br /> Proof of Coverage JAUTHORiML) <br /> EXRATLD ANY bNH THEABOVE HEREOBE NOTICEIEYVILL BES BE SLIVERED RM <br /> RDANCE WITH THE POLICY PROVISIONS. <br /> REPRESENTATIVE <br /> ACORD 25(2010/05) The ACORD name and logo are registered marks 2of ACORD ACORD CORPORATION. All rights reserved. <br />