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A--CQR-D. CERTIFICAIS OF LIABILITY INSURAW OP ID XC011 DATE IMMIDD/Yyyy) <br /> SE6 01 <br /> PRODUCER _ I <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION -0_8 <br /> George Petersen Ins Agency <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> P. O. Box 3539 HOLDER,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR <br /> 627 College Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> Santa Rosa CA 95402 <br /> Phone: 707-525-4150 Pax:707-525-4175 INSURERS AFFORDING COVERAGE NAIC <br /> INSURED INSURER A: Cypress Insurance CO an_ <br /> INSURERS: <br /> Service Station System, Tac. INSURER C: <br /> 6 Quinn Avenue <br /> San Jose CA 95112 INSURER D; <br /> COVERAGES <br /> INSURERE: <br /> THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ASOVEFOR THE POLICYPERIOMINDICATED.NOTWITHSTANDING <br /> ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THISCERTIFICATE MAY-SE ISSUED OR <br /> MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH <br /> POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS, <br /> tti <br /> EFIFECTIV <br /> LTR WERE TYPE OF INSURANCE POLICY NUMBER DAPOTEI I DATWIMMIDOMI LIMITS <br /> GENERAL LIABILITY EACHOCCURRENCE <br /> COMMERCIAL GENERAL LIABILITY UAMAISE-1707RENICU <br /> CLAIMS MADE F70CCUR PREMISES JE!.2�mnce . S <br /> MED EXP{Anyone person) s <br /> PERSONALE ADV INJURY S <br /> GENEFIALAGGREGATE 5 <br /> GERL AGGREGATE LIMIT APPLIES PER, PRODUCTS-COMPIOP AGG 5 <br /> n <br /> POLICYF—�JPERCOT [7 LOC <br /> AUTOMOBILE LIABILITY <br /> COMBINED SINGLE LIMIT <br /> ANY AUTO (Ea accident) 5 <br /> ALL OWNED AUTOS BODILY INJURY <br /> SCHEDULED AUTOS (Per person) S <br /> HIRED AUTOS BODILY INJURY <br /> NON-OWNED AUTOS (Per accident) $ <br /> PROPERTY DAMAGE <br /> (Per accident) <br /> LGARAGE LIABILITY AUTO ONLY-EA ACCIDENT 5 <br /> HANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG 5 <br /> FXCESSIUMSRELLA LIABILITY EACH OCCURRENCE S <br /> 7 OCCUR D CLAIMS MADE AGGREGATE S <br /> DEDUCTIBLE <br /> RETENTION S <br /> IT <br /> WORKERS COMPENSATION AND WC STATU UTW <br /> X TORYIMIfj ER <br /> EMPLOYERS!LIABILITY LI <br /> A ANY PROFRIETORIPARTNERIEXECUTIVE 3310020636081 06/04/08 06/04/09 E.L.EACH ACCIDENT 51000000 <br /> OFFICERIMEMBER'EXCLUDED? E.L.DISEASE-EA EMPLOYEES 1000000 <br /> 11401 describe under E.L.DISEASE-POLICY LIMIT S 100000 <br /> SPECIAL PROVISIONS below <br /> OTHER <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONSAIDDEDIDYIENDORSAINIOff I SPECIALPROVISIONS <br /> Re: License #485184 <br /> Evidence of Workers' Compensation Coverage. <br /> Ten Day Notice of Cancellation in the event of non-payment of premium. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY•OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 1EXPIRATION <br /> DATETHEREOF,THE ISSUING INSURER WILL ENDEAVOR To MAIL 30* DAYSWRITTEN <br /> NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LE",BUT FAILURE TO DO 80 SHALL <br /> Contractors State License Boar IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS an <br /> PO Box 26000 REPRESENTATIVES. <br /> Sacramento CA 95826 A= TIVE <br /> ACORD 25(2001108) 0 ACORD CORPORATION 1988 <br />