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L] <br />aSERVSTA-CL DWATTS <br />' ' ' ''T' <br />NSURANCE <br />DATE(MMDD/YYYY)a <br />1 5/23/2016 <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 <br />George Petersen Insurance Agency, Inc. <br />P.O. Box 3539 <br />Santa Rosa, CA 95402 <br />CONTACT <br />NAME: <br />PHONE 70T 525-4150 FAX <br />AIC xt No E : ) A/c No : (707) 525-4175 <br />E-MAIL <br />ADDRESS: I�9P info ins.com <br />INSURER(S) AFFORDING COVERAGE MAIC # <br />INSURER A: Insurance Company of the West 127847 <br />INSURED <br />INSURER 8: ' <br />INSURER C: <br />Service Station Systems, Inc. <br />INSURER D: <br />3224 Regional Parkway <br />Santa Rosa, CA 95403 <br />INSURER E: <br />INSURER F <br />GENERAL AGGREGATE $ <br />910' =1 11--i <br />CERTIFICATE NUMBER: <br />REVISION NUMBEEL,,, <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A V FO PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WI ESE Chi 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 />ILTR <br />TYPE OF INSURANCE <br />NSD <br />WVD <br />POLICY NUMBER <br />MMIDD� <br />MMIDD/YYCY YY <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE E]OCCUR <br />EACH OCCURRENCE $ <br />�T3E'T'i5 RF_NTE19 <br />PREMISES Ea occurrence $ <br />MED EXP (Any one person) $ <br />PERSONAL & ADV INJURY $ <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRO - <br />POLICY JECT LOC <br />OTHER: <br />GENERAL AGGREGATE $ <br />PRODUCTS - COMP/OP AGG $ <br />$ <br />AUTOMOBILE <br />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 acctlent <br />( ) $ <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' LIABILITY <br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y / NPL <br />OFFICERIMEMBER EXCLUDE ❑ <br />D? <br />(Mandatory In NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />N /A <br />5021307 04 <br />06/04/2016 <br />06/04/2017 <br />PER TH- <br />XSTATUTE ER <br />E.L. EACH ACCIDENT $ 1,000,000 <br />E.L. DISEASE - EA EMPLOYE $ 1,000,000 <br />E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) <br />RE: License #485184 <br />_a.Cr[ a IrH.A I C MULUrM GANGCLLA I IUN <br />Contractor State License Board Workers Compensation Unit <br />PO Box 26000 <br />Sacramento, CA 95826 <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 />©1988-2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD <br />