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SERVSTA-CL WINTER <br />P <br />ATE (MM/DONYYY) <br />IFI F LIABILITY I 6/8/2015 <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 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 endorsement(s). <br />PRODUCER CONTACT <br />NAME: <br />George Petersen Insurance Agency, Inc. BONNo. Ext): (707) 525-4150 FAXA/C No ; (707) 525-4175 <br />P.O. Box 3539 E-MAIL <br />Santa Rosa, CA 95402 ADDRESS: info@gpins.com <br />Insurance <br />INSURED INSURER B: <br />Service Station Systems, Inc. INsuRER c <br />3224 Regional Parkway INSURER D <br />Santa Rosa, CA 95403 IWSIIRFR G <br />AFFORDING <br />COVFRAGFS CERTIFICATE NUMRFR- L. -I 1A5 N1Pf <br />VA <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INS RE NA E E 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 <br />LTR <br />TYPE OF INSURANCE <br />IND <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MMIDD <br />POLICY EXP <br />MMIDD <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE FIOCCUR <br />EACH OCCURRENCE $ <br />DAMAGE TO RENT - <br />PREMISES Ea occurrence $ <br />MED EXP (Any one person) $ <br />PERSONAL & ADV INJURY $ <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY F—I PROJECT ❑ LOC <br />OTHER: <br />GENERAL AGGREGATE $ <br />PRODUCTS - COMP/OP AGG $ <br />$ <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />NON -OWNED <br />HIRED AUTOS AUTOS <br />COMBINED SINGLE LIMIT $ <br />Ea accident <br />BODILY INJURY (Per person) $ <br />BODILY INJURY (Per accident) $ <br />PROPERTY DAMAGE $ <br />Per accident <br />UMBRELLA LIAB <br />EXCESS LIAB <br />OCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />DED I I RETENTION $ <br />$ <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITYSTATUTE <br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y I❑N <br />OFFICERIMEMBER EXCLUDED? <br />(Mandatory In NH) <br />If Yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />N / A <br />PL502130703 <br />06/04/2015 <br />06/04/2016 <br />PER TH- <br />X OR <br />E.L. EACH ACCIDENT $ 11000,000 <br />E.L. DISEASE - EA EMPLOYEd $ 1,000,000 <br />E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) <br />*Proof of Coverage* <br />rFRTll=trATF 41n1 ni=p rANrFl I ATION <br />©1988-2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Insured's Copy <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />©1988-2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD <br />