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* RECEIVED 0 <br />CERDEC 0 2 2015 SERVSTA-CL NWINTER <br />TIFICATE O <br />FUAR69UN.-sURANDATE (MM/DDNYYY) <br />C�E 6/812615 <br />THIS CERTIFICATE IS ISSUED AS A MATTER. OF INFO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />7 <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGAtIVL Wt E DOR 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.011 PRODUCER, AND THE CERTIFICATE HOLQEIR,.. <br />IMPORTANT: If the certificate holder Is an ADDITIONAL IN9URED, the pollcy(jes) 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 T <br />NAME: <br />Georae Petersen Insurance Agency, Inc. PHONE <br />P.O. ox 3539 r.Nz=,L7G7L -4150 N 07 25-4175 <br />125, <br />Santa Rosa, CA 95402 <br />lnfo0_Dqp1ns.coml <br />INSURED <br />Service Station Systems, Inc. <br />3224 Regional Parkway <br />Santa Rosa, CA 95403 <br />I I IN3URERF: I I <br />r0VFRAr.F1_4 rFRTiFirATF NtIMRFR- RFVI_qfbN,NtIMAPI4- <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 ISSUBJEC-TTO 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 />AMEMM, <br />INSO <br />WVO <br />POLICY NUMBER <br />POLICY EFF <br />(MMtRDfYyyYI <br />(MM <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE El OCCUR <br />EACH OCCURRENCE $ <br />PREMISES (Ea occurrence ) $ <br />MEO EXP (Any onoperson) $ <br />PERSONALA AOV INJURY $ <br />GEWL AGGREGATE LIMIT APPLIES PER: <br />� POLICY O. I LOC <br />FE <br />OTHER: l JEPRCT <br />GENERAL AGGREGATE $ <br />PRODUCTS - COMP/OP AGG $ <br />$ <br />'AUTOMOBILE LIABIUTY <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />A <br />AUTOS [AUTOS <br />HIRED AUTOS NON -OWNED <br />AUTOS <br />"*IN IMIT <br />(eo, A. t dZI 2[NGLEt $, <br />BODILY INJURY (Per -person) $ <br />BODILY INJURY (Per acciderl) $ <br />0 MA <br />(P 0 r XiRd TI.YY <br />UMBRELLA LIAS OCCUR <br />EXCESS UAB CLAIMS -MADE <br />,.__._T.__.__. <br />DED I RETENTION$ <br />EACH OCCURRENCE <br />AGGREGATE $ <br />A <br />WORKERS COMPENSATIONX <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRI[ETORIPARTNERIEXECUTIVE <br />OFFICER/MEMBER EXCLUDED?NIA <br />(Mandatory In NH) <br />If yeS desc be nder, <br />DESCRIPTION OF OPERATIONS below <br />WPI -5021130703 <br />06104/2015 <br />06/04/2016 <br />A L <br />__ 1 STATUTE OTH <br />E.L. EACH ACOIDENTRt�$ 1,000,000 <br />E.L. DISEASE - EA EMP YEE1 $ 1.0.00,000 <br />E.L. DISEASE - POLICY LIMIT 1 $ 1,00000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACOAD.101, AddItIonal Remarks Schedule, maybe atachodif more space is -required) <br />*Proof of Coverage* <br />SHOULD ANY OF THE ABOVE I?ESCRIS.ED POLICIES BE CANCELLED BEFORE <br />Insured*s Copy THE EXPIRATION DATETHEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />(01989-2014AGURILIGOKFUKAIIIIIIJIN. All ngntsroserveo. <br />ACORD 25 (2014101) The ACORD name aOd logo are registered marks of ACORD <br />