Laserfiche WebLink
AC®• SERVSTA-01 IU( <br /> �-- CERTIFICATE OF LIABILITY INSURANCE F DATE(MMOIrli <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMA1 012 <br /> TION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.TI <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLIQ <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORM <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: N the i—w Ricate holder k in ADDITIONAL INSURED,the Policy(tes)must be endorsed. H SUBROGATION IS WAIVED,subject <br /> the terms and conditions s the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to 1 <br /> hM hoiden In lieu of such endorsement(s). <br /> PRODUCER License#0603247 <br /> George Petersen Insurance Agency,Inc. NAME: <br /> P.O. x 3539 PHONE ;(800 236-9046 <br /> Santa Rosa,CA 95402 AIC NO:(888 579-274: <br /> ADDRESS: <br /> flISURER(6)AFFORDING COVERAGE MAIC 1 <br /> INSURED <br /> INSURER A:ICW Group <br /> INSURER 8: <br /> Service Station Systems,Inc. SURER C <br /> 689 Quinn Ave INSURER D: <br /> San Jose,CA 95112 <br /> INSURER E: <br /> COVERAGESINSURER F. <br /> CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE-fNSURED NAMED ABOVE FOR THE POLICY PERIOI <br /> -INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THI: <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 /> NR TYPE OF INSURANCE POLICY NUMBER MIDDM YY D <br /> GENERAL UABILITY LIMITS <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ <br /> CLAIMS-MADE F-1OCCUR PREMISES Ea occurrence $ <br /> MED EXP(An one person $ <br /> PERSONAL 6 ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ <br /> POLICY PRO- LOC PRODUCTS-COMPIOP AGG $ <br /> AUTOMOBILE LJABIL.rrY $ <br /> ANYAUTO dent <br /> �� <br /> ED SCHEDULED <br /> BODILY INJURY(Per person) s-- <br /> NON-OWNED BODILY INJURY(Per accident) $ --� <br /> AUTOS <br /> HIRED AUTOS AUTOS �O a�n DAMAGE $ <br /> UMBRELLA LIAR OCCUR $ <br /> EXCESS LIAR CLAIMS-MADE EACH OCCURRENCE $ <br /> DAGGREGATE $ <br /> W RETENTION$ <br /> (YORKERS COMPENSATION $ <br /> AND EMPLOYERS'LIABILITY X WC STATU- OTH- <br /> A 11— <br /> ANY PROPRIETORIPARTNERIEXECUTIVE YIN PL502130700 6/4/2012 6/4/201$ <br /> OFFICERMIEMBER EXCLUDED? N I A E.L.EACH ACCIDENT <br /> (Mandistory in NN) <br /> N dtedbe under E.L.DISEASE-EA EMPLOYE $ 1,000,00( <br /> DESCRIPTION OF OPERATIONS below <br /> E.L.DISEASE-POLICY LIMIT $ 1,000,00( <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,N more space is required) <br /> Proof of coverage <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Proof of Coverage THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> .AUTHORI�D REPRESENTATIVE <br /> 01. <br /> ®1988.2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010105) The ACORD name and logo are registered marcs of ACORD <br />