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S <br />ACCiR®" ERVSTA-01 IUCh <br />CERTIFICATE OF LIABILITY INSURANCE DATE(MMMDIVM <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIEI <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZE[ <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the poliey(Ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terns and conditions of the policy, certain Policies may require an endorsement. A Statement on this <br />certificate holder in lieu of such endorsement(s). does not confer rights to the <br />PRODUCER License # 0603247 <br />George Petersen Insurance Agency, Inc. wuxE: <br />P.O. ox 3539 vHaeE : (800) 236.9046 <br />Santa Rosa, CA 95402 E M AX No): 888 579-2743 <br />INSURED <br />Service Station Systems, Inc. <br />680 Quinn Ave <br />San Jose, CA 95112 <br />IV <br />---I—,",— — MBER: <br />HIS 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 />R111 GENERAL LMBILI�OF <br />INSURANCE POLICY NUMBER Mpp/ryyY Mppmh, <br />COMMERCIAL GENERAL LIABILITY <br />7 CLAIMS -MADE EJOCCUR <br />LIMIT APPLIES PER: <br />AUTOMOBILE LIABILITY <br />$ <br />ANY AUTO <br />$ <br />D <br />D <br />AUTO <br />8 <br />AUTOS <br />HIRED AUTOS <br />ANONO-0WNED <br />UT <br />UMBRELLA LIAR OCCUR <br />EXCESS LIAB <br />' LIABILITY <br />A ANYAND PROPEMPLOYERSRIETORlPARTNERIEXECUTIVE <br />YIN <br />OFFICERIMEMBER EXCLUDED? D IN/A <br />[MalMamry In NMI <br />cnvn VI:t:UKRENCE <br />$ <br />lMrA' SE�F�ax ice <br />$ <br />MED EXP (Any one pennon) <br />$ <br />PERSONAL& ADV INJURY <br />$ <br />GENERAL AGGREGATE <br />$ <br />PRODUCTS - COMPlOP AGG <br />S <br />$ <br />COMBINED IN L L MIT <br />Ea sold M <br />BODILY INJURY (Per person) <br />$ <br />BODILY INJURY (Per accident) $ <br />ut: <br />LEM accident) <br />$ <br />S <br />EACH OCCURRENCE <br />e <br />6/4/2012 6/4/2013 E.L. EACH ACCIDENT $_ 1 <br />E.L. DISEASE - EA EMPLOYE $ 1 <br />E.L. DISEASE - POLICY LIMIT $ 1 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, N more space is required) <br />=roof of Coverage <br />Proof of Coverage <br />ff7 <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 />AUTHORED REPRESENTATIVE <br />®1988-2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />