Laserfiche WebLink
r. --� XPRES -1 OP D : CV <br /> ACORO`" <br /> �- . CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) <br /> 08/31 /2021 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED 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 have ADDITIONAL INSURED provisions or be endorsed . <br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement (s). <br /> PRODUCER 209-847-3065 coME <br /> NTACT Kenneth Verschelden <br /> Basi Insurance Services, Inc. PHONE 209-847-3065 FAX 209 -848-4931 <br /> 1491 E G Street (A/C, No, Ext): (A/C, No): <br /> Oakdale, CA 95361 E-MAIE . kenny@basiinsurance .com <br /> Kenneth Verschelden <br /> INSURERISJ AFFORDING COVERAGE NAIC # <br /> INSURER A : State Compensation Ins . Fund 35076 <br /> INSURED INSURER B : '.. <br /> Xpress Auto Services Inc <br /> DBA: Car Wash Technology INSURER C : <br /> Xpress Technical Services Inc. <br /> DBA: IEC Services INSURER D <br /> P.O. BOX 11160 INSURER E : <br /> Oakdale, CA 95361 <br /> INSURER F : '. <br /> COVERAGES CERTIFICATE NUMBER : REVISION NUMBER : <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN , THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, <br /> INSR TYPE OF INSURANCE ADDL SUB POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br /> I TRMMIDDIYYYYI WWI <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ <br /> CLAIMS-MADE OCCUR DAMAGE TO RENTED <br /> PREMISES Ea occurrence $ <br /> MED EXP (Any oneperson) $ <br /> PERSONAL & ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE <br /> POLICY JE� LOC <br /> ❑ PRODUCTS - COMP/OP AGG $ <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY Ea ace den SINGLE LIMIT $ '... <br /> ANY AUTO BODILY INJURY Perperson) $ <br /> OWNED SCHEDULED <br /> AUTOS ONLY AUTOS BODILY INJURY Per accident $ <br /> HIRED NON-OWNED PR E13TYt AMAGE $ <br /> AUTOS ONLY AUTOS ONLY <br /> $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION $ <br /> A WORKERS COMPENSATION X STATUTE X OTH- <br /> ER <br /> AND EMPLOYERS' Y / N LIABILITY -- -- <br /> 9286967-21 08/29/2021 08/29/2022 ER 1 , 000,000 <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? N / A 1 000 000 <br /> (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ <br /> If yes, describe under 1 , 000 ,000 <br /> DESCRIPTION OF OPERATIONS below E. L. DISEASE - POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101 , Additional Remarks Schedule, may be attached if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Proof of insurance ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION . All rights reserved . <br /> The ACORD name and logo are registered marks of ACORD <br />