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ABLEM-1 OP ID: S4 <br />'4�,....,.., �' CERTIFICATE F LIABILITY INSURANCE09130111 <br />DAT11 <br />09/30 <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(les) 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 endomemen s . <br />PRODUCER 707-525 415 <br />George Petersen Ins Agency707-525-4175 <br />P. 0. Box 3638 <br />627 College Avenue <br />Santa Rosa, CA 95402 <br />c <br />PHONEFAX <br />Eat : Arc No), <br />ADORE - <br />INSURER[Sl AFFORDING COVERAGE NAtCS <br />Douglas Dilley <br />INSURERA:ICW Group <br />INSURED Able Maintenance, Inc. <br />3224 Regional Parkway <br />Santa Rasa, CA 95403 <br />INSURER B: <br />tNsuRERc: <br />INSURER D. - <br />:INSURER <br />INS E <br />INSURER F <br />MED EXP (Any one person) $ <br />[*i*]i/ 4: -Tei d l j 11=11 RI iT11 *4 �k 1 a , , <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 />NSR <br />ILm <br />TYPE OF INSURANCE <br />DOL <br />SUBN <br />POLICY NUMBER <br />EFF <br />IMPOLICYMIDDIVYWIUNITS <br />PO <br />EACH OCCURRENCE $ <br />GENERAL LIABILITY <br />PREMISO (Ea o nceS <br />COMMERCIAL GENERA. LIABILITY <br />CLAM"ADE D OCCUR <br />MED EXP (Any one person) $ <br />PERSONAL & ADV INJURY S <br />GENERAL AGGREGATE S <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMPIOP AGG $ <br />POLICY P - Ej LOC <br />S <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT $ <br />ANY AUTO <br />BODILY INJURY (Per person) 5 <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY Par accident) S <br />NON -OWNED <br />HIRED AUTOS <br />p e E 5 <br />$ <br />UMBRELLA UAS <br />HOCCUR <br />EACH OCCURRENCE S <br />HIEXCESS <br />LIAD <br />CLAIMS-IAADE <br />AGGREGATE $ <br />DED I I RETENTION s <br />$ <br />WORRIERS COMPENSATION <br />WC STATU in <br />A <br />EMPLOYERS' LIABILITY Y I N <br />ANY PROPRIETORIPARTNERIEXECUTIVEL600060303 <br />OFFlCIEMBER EXCLUDED? ® <br />N / A <br />10/01/11 <br />10101/12 <br />E.L. EACH ACCIDENT S 1,000,00 <br />_ <br />E.L. DISEASE - EA EMPLOYEE 5 1,000,00 <br />It Myer, Chantm ary ht Nunder <br />DESCRIPTION OF OPERATIONS below <br />— - — <br />E.L. DISEASE - POLICY LIMIT S 1,000,00 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, N more space Is required) <br />RE: License #312844 <br />Proof of Coverage <br />Contractors State License <br />Board - Workers Comp Unit <br />PO BOX 26000 <br />Sacramento, CA 95828 <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 />(32 q-3?— 1 <br />©1988 2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD <br />