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BZSER-1 OP ID; BB <br /> ii DATE (MMIDDIY YY)OF <br /> CERTIR AT <br /> LIABILIT"Y"' <br /> „ ,. 1 I I 02120120 <br /> . 10 <br /> THIS S UPON THE <br /> TIFICATE <br /> CERTIFICATECDOES ATE ISNOTATE IS 'SSUAFFIRMATVELYEOR NEGATIVELYR OF AMEND , EXTEND OR ALTER ON ONLY AND CONFERS NO RTHE �COVERAGE AFFORRDED 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• !t SUBROGATION S 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 . MRIl <br /> CT <br /> PRODUCER Phone* 7-52 <br /> McDowall & Keeney Ins Assoc Fail 916-587-31E,n : c N4 <br /> 865 Howe Ave, Suite 200 <br /> Sacramento, CA 95825 SS: ISO <br /> Jane Allyn McDovwall INSURERS AFFORDING COVERAGE NAIC <br /> ! INSURER A ! Surplus insurance CO, 23787 <br /> INSURED $Z Service Station Maintenance ER B : United Financial Casual CO. 24052 <br /> Inc ERC ; National Liabili & FireInsp , O. Box 933 ER D :Vilest Sacramento, CA 95894 ER E ;ER F <br /> COVERAGES <br /> CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS <br /> IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE OLiCY PERI <br /> INDICATEDCERTIFICA MAY T STANDI OR NMAY PERRE HENT, INSURTERM ANCE CE AFFORDCONDITIO ED BY THE PON OF ANY LICIES D SCRIBEDCT OR OTHER OHEREIN S CUMENT 8UB ECTTH PTO ALL O THE TERMS , <br /> EXCLUSlgNS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMIT$ <br /> IL TYPE OF INSURANCE POLICY NUMBER MMIOD/YYYY MMtDd 1 ,444,44 <br /> Alk EACH OCCURRENCE S <br /> GENERAL LIABILITY ; ` Y_ 144,00 <br /> EMP20001971 -41 02/188124 02115/21 PR isss Eaocwnii S 14:a4 <br /> A X COMMERCIAL GENERAL LIABILITY MED EXP ((AT ono cerson) g <br /> CLAIMS-MADE L ” I OCCUR ` PERSONAL BADVINJURY 9 � 1 ,444,40 <br /> X Cont Pollution q GENERAL AGGREGATE S 21004140 <br /> X ( PRODUCTS - COMPIOPAGG S 21004 ,00 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: I $ <br /> X POLICY 1F O LOC I OMBINED SINGLE LIMIT s '1 ,0(j4,4{j <br /> accidanl _ <br /> AUTOMOBILE LIABILITYBODILYINJURY (Perperson) S <br /> a1s26es2.4 4211s1zo 4s11sra4 _ <br /> B ANY AUTO SODILY INJURY (Per soddeol) 5 <br /> ALL OWNED X SCHEDULED PRO ERTY AMAGE $ <br /> AUTOS AUTOS <br /> NON•OWNED Per acc dents <br /> X HIRED AUTOS AUTOS S <br /> EACH OCCURRENCE $ <br /> UMBRELLA LIAS OCCUR AGGREGATE i $ <br /> EXCESS UAS CLAIMS-MADE L$,--•------ <br /> i <br /> DEC RETENTIONS X WC STATU- O HA <br /> WORKERS COMPENSATION 1 ,400 ,44 <br /> AND EMPLOYERS LIABILITY V9W0488350 '10127119 14127(24 £.L. EACH ACCIDENT _ S 1 004 40 <br /> C ANY PROPRiETORIPARTNERIEXEC'dill Y( � � NIA E.L. DISEASE - EA EMPLOYEES > > <br /> OFFIC9RIMEMBER EXCLUDED? Ell 'I 404,40 <br /> (Mandatory in NSI) FL. DISEASE - POLICY LIMIT S <br /> If ones, desTIONunder 42!15124 42/15121 Aggregate 2,440 ,44 <br /> DESCRiPTiON OP OPERATIONS below EMP20001971 -41 <br /> A CPL and PL Each 11000,00 <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 1010 Additional Romarica Sch®dole, If more apace is required) <br /> i <br /> 11 111 Wool <br /> CANCEL6&1T1 14 <br /> 0tERTtFI0^TE t-IOL.DrzR MINIM ~ IFC3RiNPC1 <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> For Information Only ACCORDANCE WITH THE POLICY PROVISIONS* <br /> AUTHORMED REPRESENTATIVE <br /> WHOM <br /> d 1988.2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25 (2414105) The ACORD name and logo are registered marks of ACORD <br />�i <br />