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BZSER4 OP ID : BB CERTIFICATE OF LIABILITY INSURANCEDATE (MMIDD/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 HQLDER, IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy( les) 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 -567.3233 NAMEACT McDowall a Keeney Ins Assoc Fax' 916 .56?-3155 PHorIE A 865 Howe Ave, Suite 200 A/C No): Sacramento, CA 95825 E9MAILss: Jane Allyn McDowall INSURERS AFFORDING COVERAGE NAIC # INSURERa : Admiral Insurance Company 124856 INSURED BZ Service Station Maintenance INSURERS : Nationwide Mutual Insurance Co 23787 Inc F P. O. Sox 933 INSURER C : National Liability & Fire Ins 20052 West Sacramento , CA 95691 INSURER D : INSURER E : INSURER F4: 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, ILTR TYPE OF INSURANCE VON = PO C EFF PO I Y EXP POLICY NUMBER MM/DD/YYYY MM/DD/YYYY OMITS GENERAL LIABILITY EACH OCCURRENCE $ 10000,00 A X COMMERCIAL GENERAL LIABILITY X X FEI•ECC-23429-02 02/15/19 02/15/20 PREMISES Ea occurrence $ 50100 CLAMS ADE 5XI OCCUR MED EXP (Any one person) $ • _ 5000 X Cont P011ution PERSONAL & ADV INJURY $ 11000,00 GENERAL AGGREGATE $ 21000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS • COMPIOP AGG $ 2,000100 X POLICY JECT PRO- LOC $ AUTOMOBILE LIABILITYEa SBI IdeD SINGLQ LIMIT $ _1 ,000,00 B X ANY AUTO X ACPBA3037670604 02/16/19 02/16/20 BODILY INJURY (Perperson) s ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS. NON-OWNED PROPER DAMA E AUTOS eraccident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB El CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' UABILITY X C ANY PROPRIETOR/PARTNERIEXECUTIVE Y / N X V9WC921126 10/27/18 .10/27/19 E, L. EACHTORY1 IMI ACCIDEmr $ 1 ,000,00 OFFICER/MEMBER EXCLUDED? N / A (Mandatory In NH) -- If yes describe under E, L. DISEASE - ,EA EMPLOYEE $ 11000,00 DESCRIPTION OF OPERATIONS below A Prof Liability FEI•ECC-23429.02 02/15/19 02/15120 Aggregate L °ISEASE POLICY LIMIT $ 1 ,000,00 21000,00 Each 11000100 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, 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 SYSC0-5 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 © 1988.2010 ACORD CORPORATION. All rights reserved , ACORD 25 (2010105 ) The ACORD name and logo are registered marks of ACORD r