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BZSERA OP ID : BB �+ C b C r �+ �^► DATE (MMIDDNYYY) - CERTIFICATE f LIILIY INSURANCE 02126119 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(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 endorsement (s). coNracT PRODUCER Phone: 916-567.3233 NAME: McDowall & Keeney Ins Assoc Fax: 916-567-3155 F- FAX No): 865 Howe Ave, Suite 200 E9MAJL Sacramento, CA 95825 ADDRESS: Jane Allyn McDowall INSURERIS) AFFORDING COVERAGE NAIC # INSURER A : Admiral Insurance Company 24856 INSURED BZ Service Station Maintenance INSURER a : Nationwide Mutual Insurance Co 23787 Inc INSURER C 1. National Liability & Fire Ins 20052 P . 0 . Box 933 INSURER D West Sacramento , CA 95691 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. ILTR L St POLIO EFF POU Y EXP LWITS TYPE OF INSURANCE POLICY NUMBER MMIDD MMl00 GENERAL LIABILITY EACH OCCURRENCE S _ 1 rOOOrOO A X COMMERCIAL GENERAL LIABILITY X X FEI-ECC-23429-02 02/15119 02115/20 pREMISEDAMA s Eaocaurance 5 50,00 CLAIMS-MADE Q OCCUR MED EXP (Any one person) S 6100 X Cont Pollution PERSONAL & ADV INJURY $ 11000,00 GENERAL AGGREGATE 5 23000,00 GEN'L AGGREGATE LIMIT APPLIES PER, PRODUCTS - COMPlOP AGG 5 21000,00 R X POLICY JFGT 71 PRO• LOC 5 AUTOMOBILE LIABILITY COMBINED S 1 ,000,00 B X ANYAUTO X ACPBA3037670604 02/15/19 02/15/20 BODILY INJURY (Per.parsw) 5 ALLOWNED SCHEDULED BODILY INJURY (Per accident) S AUTOS AUTOS PROPERTYDAMAGE $ NON•OWNED Per athdant HIRED AUTOS AUTOS S UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIA9 CLAIMS-MADE AGGREGATE S $ DED RETENTIONS WC STATU- OTH- WORKERS COMPENSATION X AND EMPLOYERS LIABILITYYIN D FN NIA X 9WC921126 10/27/18 ,10127119 E.L. EACH ACCIDENT S OFFICERIMEMBEREXCLUDED9 E.L. DISEASE * EA EMPLOYEE1 S 11000,00 (Mandatory In NH) If yes, describe undar E L DISEASE - POLICY LIMIT S 1 ,000,00 DESCRIPTION OF OPERATIONS below A Prof Liability FEl•ECC-23429-02 02116/19 02115/20 Aggregate 21000,00 Each 13000,00 DESCRIPTION OF OPERATIONS I LOCATIONSd VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more apace 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 - 07120 aiver 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-5 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Sysco Corporation THE WITH `THE POUCY PROVISIONS. Insurance Compliance PO Box 100085- CY AUTHORIZED REPRESENTATIVE Duluth, GA 30096 . 0 1988.2oio ACORD CORPORATION. All rights reserved . ACORD 26 (2010105) The ACORD name and logo are registered marks of ACORD