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----� SERVSTA-CL DWATTS <br /> ACRO CERTIFICATE OF LIABILITY INSURANCE o ..z/2020 Y) <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 have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER NAM <br /> George Petersen Insurance Agency,Inc. PHONE <br /> P.O.Box 3539 (A/CC,No,Ext):(707)525-4150 (A/C Ne):(707)525-4175 <br /> Santa Rosa,CA 95402 A M RIL �info@gpins.com <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A:State Compensation Insurance Fund 35076 <br /> INSURED 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 TypE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXPITR IL (MMIDDIYYYYI LIMITS <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ <br /> CLAIMS-MADE 7 OCCUR PRMMI E S( a D occurrence) $ <br /> MED EXP(Any oneperson) $ <br /> PERSONAL&ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ <br /> POLICY❑PRO F] LOC PRODUCTS-COMP/OP AGG $ <br /> JEF1 CT <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED aaccenSINGLE LIMIT $ <br /> ANY AUTO BODILY INJURY Perperson) $ <br /> ATEOWNED SCHEDULED <br /> ONLY AUTOSSWN BODILY INJURY Per accident $ <br /> AUTOS ONLY ALTOS ONL� PeOr acEcRdent AMAGE $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> A WORKERS COMPENSATION X PER ER <br /> OTH- <br /> AND EMPLOYERS'LIABILITY T T T <br /> Y/N 9277131-2020 614/2020 6/4/2021 1,000,000 <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? F--] NIA 1,000,000 <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ <br /> It yes,describe under 1,000,000 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) <br /> RE: Proof of Coverage <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Service Station Systems,Inc. ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />