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C <br />® <br />TE (MMIDD/YYM <br />[:!9/27/2013 <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(iss) 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 endorsements . <br />PRODUCER <br />George Petersen Insurance Agency, Inc. <br />P.O. Box 3539 <br />Santa Rosa, CA 95402 <br />CONTACT <br />NAME: <br />PHONE 800 236-9046 4979 FAx <br />AIC No Ell: ( ) AIC No ,(707) 525-4175 <br />o, <br />MN <br />MPOM DY EXP <br />INSURERS AFFORDING COVERAGE NAIC q <br />INSURER A: Westchester Surplus Lines Insurance Co. <br />INSURED <br />Able Maintenance Inc. <br />3224 Regional Parkway <br />Santa Rosa, CA 95403 <br />INSURER B: Wausau Underwriters Insurance <br />INSURER C: American Fire & Casualty <br />INSURER D: State Compensation Ins. Fund <br />INSURER E: <br />INSURER F: <br />/6191`/a f_Ici H::I AIIa[y-I 19:9 0Illi !rl:)A • , : - <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 CONTRACTOR 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 />ILSRR <br />TYPE OF INSURANCE <br />L <br />POLICY NUMBER <br />MADDSUBRPMOUpY EFF <br />MPOM DY EXP <br />LIMITS <br />A <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS-MADE ® OCCUR <br />X Pollution & Profess. <br />G22070800008 <br />10/11/2012 <br />10/11/2013 <br />EACH OCCURRENCE $ 5,000,00 <br />PREMISES Me occurrence $ 50,00 <br />MED EXP (Any one person) $ 5,00 <br />PERSONAL & ADV INJURY $ 5,000,00 <br />GENERAL AGGREGATE $ 5,000,00 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICYLL PRO LOC <br />PRODUCTS - COMP/OP AGG $ 5,000,00 <br />MOLD $ 1,000,00 <br />B <br />AUTOMOBILE <br />X <br />LIABILITY <br />ANY AUTO <br />ALL AUTOS UT AUUTTOSULED <br />NON -OWNED <br />HIRED A UTOS AUTOS <br />ASJZ91459057013 <br />4/112013 <br />4/1/2014 <br />Ea aBINED SINGLE LIMIT $ 1,000,00 <br />BODILY INJURY (Per person) $ <br />BODILY INJURY (Per accident) $ <br />PROPERTY DAMAGE $ <br />Per accident <br />C <br />X <br />UMBRELLA UABX <br />EXCESS UAB <br />I OCCUR <br />CLAIMS -MADE <br />EUA1455094511 <br />4/1/2013 <br />4/1/2014 <br />EACH OCCURRENCE $ 4,000,00 <br />AGGREGATE $ 4,000,00 <br />DED I I RETENTION <br />$ <br />D <br />WORKERS COMPENSATIONH- <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y I N <br />OFFICER/MEMBER EXCLUDED? � <br />(Mandatory in NH) <br />if yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />N / A <br />9073219-13 <br />10/1/2013 <br />10/1/2014 <br />X TNRY IM TS ER <br />_ <br />E.L. EACH ACCIDENT $ 11000,00 <br />--- <br />E.L. DISEASE - EA EMPLOYEE1 $ 1,000,00 <br />E.L. DISEASE - POLICY LIMIT I $ 1,000,00 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) <br />Evidence of coverage <br />LRJ v l <br />Evidence Of Coverage <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHOORRI2QED REPRESENTATIVE <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />