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�-, RSSEI-2 OY IU: U6 <br />14 OATE (MMIDO/YYYY) <br />CERTIFICATE OF LIABILITY INSURANCE 11ro7�12 <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 NEGATIVLLY AMEND, FXTFNn OR ALTER THE COVLRAGL AFFORDED BY THE POLICIES <br />-LOW. THIS CERTIFICATE OF INSURANCE DOFS NOT CONSTITUTL A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />IRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, <br />IMPORTANT: If the certificate holder is an ADD) FIONAL INSURED, the policy(ios) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, Certain pollcies may require an endorsomont. A statement on this certificate does not confer rights to the <br />certificate holder In lieu of such endorsement(s). <br />PRODUCER CONJACI <br />Phone: 530-895-1010 NAMr. _ <br />'nterWest Insurance Services PHONE Fax <br />License #0801094 Fax: 530-895-1313 .: No Ext Arc No: __, <br />'.O. Box 8110 -MAa. <br />-A0URE3$; ----_ - -- <br />.hico, CA 95927-8110 <br />1,14—Am hHA INSURERISI AFFORDING COVERAGE <br />INSURED R.S.S.E., Inc. dba: <br />Redding Service Station Equip <br />Attn:Mark or Lynn <br />1515 Charles Drive <br />Redding, CA 96003 <br />INSURER A; Allied Insurance <br />INSURERS Homeland Ins Co of NY <br />INSURER C : State Coq!pIns Fund (CA) <br />INSURER D"_=___ <br />INSURER E <br />COVERAGES CERTIFICATE NUMBER:REVISION Numbr!A: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW NAVE BEE_N 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 />LTR -_ UB -^-- _ _._ - - ffL CYEFF P LIY P - LIMITS <br />_ TYPE OF INSURANCE POLICY NUMOER _ MM/DDVYYYY MMJOD/YYYY <br />&GENERAL LIABILITY _ EACH OCCURRENCE _ 11 3��O,DO <br />B MMERCIAL GENERAL LIABILITY 793-0003-91-0001 11/05/12 11/05/13 ETOREaTED 50,00 <br />PREMI 51E oaunanre 3 .. <br />CLAIMS•MADE Il OCCUR MEO EXP (Anyone person) S �,�0 <br />PFRSONAL & ADV INJURY s 3,000,00 <br />BX Poll & Prof <br />GEN'L AGGREGATE LIMIT APPLIES PER <br />X POLICY JECT PRO LOC <br />793-00-03-9i-0001 <br />-- <br />11/05/12 <br />11105/13 <br />GENERAL AGGREGATE s <br />PRODUCTS • COMPIOP AGG S <br />S <br />IUTOMOSILE LIABILITY <br />A X ANY AUTO <br />ALL OWNED SCHEDULED <br />%( AUTOS X NON OWNED <br />X HIRED AUTOS X AUTOS <br />ACP7814825319 <br />11/05112 <br />111D5M 3 <br />COMBINED SINGLE LIMIT <br />MEa acc dent <br />BODILY INJURY (Par Pxsvn) 3 <br />BODILY INJURY (Per accidad) 3 <br />PROPEAUTOS RTY D�-GE S <br />Jftwgigqgl <br />s <br />UMBRELLA UAB OCCUR <br />_ <br />EXCESS Lt" _- 1..,..c u. <br />EACHOCCURRENC£__y 3 <br />-- <br />AGGREGATE 3 <br />kI YYL J,n, V' <br />AND EMPLOYERS' LIABILITY ORY iiih <br />C AMWORKE/PROPRIEIRSCOMPENSATK'OR,PARTNER/EXECUTIVE YIN 9033537-12 11105/12 11/05113 E.L.EACH_ACCID£NT S 1,000,00 <br />OFOCERIMEMBER EXCLUDED? JNIAJ 1 00010 ) <br />(Mandatory in NH) E. I. DISEASE - EA EMPLOYEE 3 , <br />nEe�oeo ne, nuc noco nTi �_i_... I E.L. DISEASE - POLICY LIMIT S 1� ,�0 <br />DESCRIPTION OF OPERATIONS I LOCATIONS) VEHICLES (Attach ACORD 101, Additional Remarks Schedule, N more space is required) <br />Confirmation of Insurance Coverages. <br />(` R S. S. E., Inc. <br />1515 Charles Dr. <br />Redding, CA 96003 <br />ACORD 25 (2010105) <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 />AUTHORIZED REPRESENTATIVE <br />� 1 <br />/ <br />T © 1988-2010 ACORD CORPORATION, All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />