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BZSER-1 OP ID : BB AL> CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 02/26/19 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy( ies) "must be endorsed, if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement, A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements PRODUCER Phone: 916-$67.3233 NAME GT McDowall & Keeney Ins Assoc Fax : 916-567-3155 pyo, E FAX 865 Howe Ave, Suite 200 A/c No): Sacramento, CA 95825 E•M I Jana'Allyn McDvwall ADDR699: INSURERS AFFORDING COVERAGE NAIC # INSURER A : Admiral Insurance Company 24856 INSURED BZ Service Station Maintenance INSURER B : Nationwide Mutual InsAlrance Co 23787 Inc INSURER c : National Liability & Fire ins 20052 P. O. Box 933 West Sacramento , CA 95691 INSURER D' : INSURER E INSURER F COVERAGES CERTIFICATE NUMBER : REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE` MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR ADDLISUBI PO C EFF POLI Y EXP LTR TYPE OF INSURANCE IINSR WVD POLICY NUMBER IMMIDDIYYYYI IMM/DDNYYYILIMITS NENERAL LIABILITY EACH OCCURRENCE $ 11000000 A COMMERCIAL GENERAL LIABILITY X X FEI-ECC-23429-02 02/15/19 02/15/20 pUAMAUtz EMUS : Ea :N II:U e s 50,00 CLAIMS,MADE D OCCUR MED EXP Any ona person) $ 5,00 Cont Pollution PERSONAL & ADV INJURY $ 11000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OPAGG $ 2,000100 X POLICY PRO• LOC $ AUTOMOBILE LIABILITY Ee aBa deDISINGLF� LIMIT $ 11000,00 B X ANYAUTO X ACPBA3037670604 02/15/19 02/15/20 BODILY INJURY (Per. perwn) $ ALL AUTOS OWNED AUTOSCHEDULED BODILY INJURY (Per accident) $ HIRED AUTOS NON-OWNED PROPER DAMA E AUTOS g Peracc dent $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS•tv1ADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION WC STATU- 0TH- $ AND EMPLOYERS' UABILITY Y / N X ER C ANY PROPRIETOR/PARTNER/EXECUTIVE X V9WC921126 10/27/18 .10/27/19 E, L. EACHACCIDENT $ 1 ,000�QO OFFICERIMEMBER EXCLUDED? N / A (Mandatory In NH) If as, describe under E. L. DISEASE -,EAEMPLOYEE $ 1 ,000100 y DESCRIPTION OF OPERATIONS below A Prof Liability E:L: DISFJI5E - POLICY LIMIT $ 11000100 tY FEI-ECC-23429-02 02/15/19 02/15/20 Aggregate 21000,00 Each 1 ,000100 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 10i, Additional Remarks Schedule, If more space Is required) Sysco Corporation , its Subsidiaries , Affiliates & Divisions are named as Additional Insured , per written contract per attached CG 20, 37 07 04 and Waiver of Subrogation applies per ECC- 320 - 0712 , Waiver of Subrogation . for Comm Auto per AC 70 05 03 16 . Waiver of Subrogation for Workers Comp per WC 04 03 06 , CERTIFICATE HOLDER CANCELLATION SYSCO-S SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Sysco Corporation THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Insurance Compliance ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 100085- CY Duluth , GA 30096 AUTHORIZED REPRESENTATIVE � - Sl� © 1988 .2010 ACORD CORPORATION. All rights reserved , ACORD 25 (2010105 ) The ACORD name and logo are registered marks of ACORD