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/ ® DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 10/1 /2021 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) . PRODUCER CONTACT NAME: GreggM Truman InterWest Insurance Services , LLC PHONE 209-724-2305 FAX No): 209-381 -2505 P . O . Box 2268 E Merced CA 95344-0268 nooARess : gtruman@iwins . com INSURERS AFFORDING COVERAGE NAIC # License#: OB01094 INSURER A : California Automobile Insurance Company 38342 INSURED TOWN&CO-05 INSURER B : Colony Insurance Company 39993 '... Town & Country Contractors Inc. INSURER C : State Comp Ins Fund CA 35076 3206 Luyung Dr Rancho Cordova CA 95742 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER : 1933230235 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, INSR ADDLSUER POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY B X COMMERCIAL GENERAL LIABILITY Y Y PACES4278165 10/1 /2021 10/1 /2022 EACH OCCURRENCE $ 1 , 000, 000 DAMAGE TO CLAIMS-MADE FX] OCCUR PREMISES (Ea occurrence $ 100 , 000 MED EXP (Any one person) _$ 5, 000 PERSONAL & ADV INJURY $ 1 , 000 ,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2, 000 ,000 '.. POLICY FX] JECT El LOC PRODUCTS - COMP/OP AGG $ 2,000, 000R '... OTHER: A AUTOMOBILE LIABILITY Y Y BA040000066036 2/27/2021 2/27/2022 COMBINED SINGLE LIMIT $ 1 , 000,000 Ea accident X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ B UMBRELLALIAB OCCUR X EXC4278166 10/1 /2021 10/1 /2022 EACH OCCURRENCE $ 51000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5 , 000, 000 DED I I RETENTION $ $ C WORKERS COMPENSATION921878221 10/1 /2021 10/1 /2022 X PER OTH- AND EMPLOYERS' LIABILITY YIN STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1 , 000,000 OFFICERIMEMBER EXCLUDED? N / A` (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1 , 000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1 , 000, 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101 , Additional Remarks Schedule, may be attached if more space is required) Re: All operations performed by Named Insured for Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS . ExtraMile Convenience Stores LLC 3875 Hopyard Road , Suite 240 AUTHORIZED REPRESENTATIVE Pleasanton CA 94588 C / © 1988 -2015 ACORD CORPORATION . All rights reserved . ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 6