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Ll <br />Cā€” <br />ATE (MM/DD/YYYY) <br />r <br />TYPE OF INSURANCE <br />sr2ar2o13 <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(ies) 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 />NAMEACT <br />PHONE g00 235-9046 x331 FAx <br />A/ No Ext : ( ) Aic No : (707) 525-4175 <br />E-MAIL <br />ADDRESS: <br />INSURER(S) AFFORDING COVERAGE MAIC N <br />INSURER A: Insurance Company of the west <br />INSURED <br />INSURER 8 <br />INSURER C; <br />Service Station Systems, Inc. <br />3224 Regional Parkway <br />Santa Rosa, CA 95403 <br />INSURER D : <br />INSURER E <br />INSURER F: <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 IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />TYPE OF INSURANCE <br />ADDLSUBR <br />POLICY NUMBER <br />POLICY EFF <br />MM/DDIYYYY <br />P L Y PLTR <br />MM D/YYYY <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE $ <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE M OCCUR <br />ED - <br />PREMISES Ea occurrence $ <br />MED EXP (Any one person) $ <br />PERSONAL & ADV INJURY $ <br />GENERAL AGGREGATE $ <br />GENT AGGREGATE LIMIT APPLIES PER: <br />POLICY r7 PRO- JECTLOC <br />PRODUCTS - COMP/OP AGG $ <br />AUTOMOBILE <br />LIABILITY <br />OMBINED INGLE LIMIT <br />Ea accident <br />ANY AUTO <br />BODILY INJURY (Per person) $ <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY (Per accident) $ <br />HIRED AUTOS AUTOSNON-O <br />(PRO <br />ROPERTY DAMAGE $ <br />Per accident <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE $ <br />EXCESS LIAB <br />CLAIMS -MADE <br />AGGREGATE $ <br />DED RETENTION$ <br />$ <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ONICERAAEMBEREXCLUPROPRIETOR/PARTNER/EXECUTIVE ā‘ <br />N/A <br />WPL502130701 <br />6/4/2013 <br />6/412014 <br />WC STATU- OTH- <br />X T Y LIMIT ER <br />E.L. EACH ACCIDENT $ 1,000,00 <br />E.L. DISEASE - FA EMPLOYE $ 1,000,00 <br />(Mandatory In NH) <br />If yes describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE E.POLICY LIMIT $ 1,000,00 <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) <br />*Proof of Coverage* <br />Insured's Copy <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 />W Tatra-ZUTu ACUKU UOKPOKATION. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />