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ABLEMAI -CL DWATTS �l �® DATE /Y yrs'" CERTIFICATE OF LIABILITY INSURANCE 9/20/2020/20211 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( ies ) must have ADDITIONAL INSURED provisions or 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 ). CONTACT PRODUCER NAME: a Petersen Insurance Agency , Inc. PHONE g (AIC, No, Ext): (707) 525-4150 FAX George No): (707 ) 525 -0175 P . O . Box 3539 EMAIL ins . com Santa Rosa , CA 95402 ADDRESS: info @gP INSURERS AFFORDING COVERAGE NAIC 11 INSURER A : Homeland Insurance Company of New York 34452 INSURED INSURER B : West American Insurance Com anv 44393 Able Maintenance, Inc . INSURER C : State Com ensation Insurance Fund 35076 3224 Regional Parkway INSURER D Santa Rosa , CA 95403 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 , ADDL SUBR POLICY EFF POLICY EXP LIMITS INSR '.. POLICY NUMBER LTR TYPE OF INSURANCE SD D IDD M DD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 10 ,0000000 CLAIMS-MADE ❑X OCCUR X X 793 -00-26 -72-0006 10/11 /2020 10/11 /2021 PREMISES DAMAGE TORENTED 50 , 000 P EMI ES Ea occurrence 5 , 000 X Pollution & Professi MED EXP An one person) $ PERSONAL & ADV INJURY $ 1000001000 10 '000 '000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ❑X PRO- ECT LOC PRODUCTS - COMP/OP AGG $ 10 ,000 ,OOO J MOLD SEE REMARK $ 1 , 0001000 OTHER: COMBINED eISINGLE LIMIT $ 1 , 000,000 B AUTOMOBILE LIABILITY Ea X ANY AUTO X X BAW (22 ) 58661065 4/1 /2021 4/1 /2022 BODILY INJURY Perperson) $ OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS ONLY AUTOS PROPERTY AMAGE AUTOS ONLY AUUTOS ONLY Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ _ EXCESS LIAB CLAIMS AGGREGATE $ DED RETENTION $ $ C WORKERS COMPENSATION X SER UTE ER OTH- AND EMPLOYERS' LIABILITY YIN 9073219 -21 10/1 /2021 10/112022 1 ,000000 ANY PROPRIETOR/PARTNER/EXECUTIVE X E. L. EACH ACCIDENT $ ,_. _ OFFICER/MEMBER EXCLUDED? ❑ NIA 1 ,000 , OOO (Mandatory in NH) E.L. DISEASE - EA EMPLOYE _ If yes, descr be under E.L. DISEASE - POLICY LIMIT $ 1 ,000 , 000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101 , Additional Remarks Schedule, may be attached if more space Is required) '... RE : All Operatins (Vacaville Fuel Oil Project) Air Systems Service and Construction , Inc . , the General Contractor, its officers , directors and employees and the Project Owner are named as Additional Insured with respects to General Liability per OBENV GE 301 (02 11 ) & OBENV GE 304 (02 11 ). Primary Wording applies per OBENV GE 319 (02 11 ). Waiver of Subrogation applies per OBENV GE 320 (0411 ) . Per Project Aggregate Limit applies per OBENV GL 300 (0211 ). Auto Liability Additional Insured applies per CA 88 10 01 13 includes Waiver of Subrogation & Cancellation Wording . Auto Primary Wording applies per CA 00 0103 06 . Worker's Compensation Waiver of Subrogation applies per 2572, All forms are attached . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Air Systems Service and Construction , Inc . ACCORDANCE WITH THE POLICY PROVISIONS. 1155 Beecher Street, Suite 100 San Leandro , CA 94577 AUTH//ORIu/Z�ED REPRESENTATIVE 19884015 ACORD 25 ( 2016103 ) © 1988 -2015 ACORD CORPORATION . All rights reserved . The ACORD name and logo are registered marks of ACORD