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SERVSTA -CL D TTS DATE (MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCEATE HOLDERo THIS fsi� izozz FCERTTHI5 CERTIFICATE IS ISSUED AS A MATTER OF R NEGATIIVELIYTAMENDION NL EXTEND OY AND R ALTER THE ERS NO HCOVERAGE AFFOTS UPON THE RDED BY THE POL C ES IFICATE DOES NOT AFFIRMATIVELY O BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSUR ER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. ADDITIONAL INSURED, the policy(ies ) must have ADDITIONAL INSURED provisions or be endorsed . IMPORTANT: if the certificate holder is an 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 suchendorsement(s). CW CT PRODUCER PHONE George Petersen Insurance Agency, Inc. (A/c Ne,�. (707 ) 6264150 _ _ jAac , &%80); (707) 525 .4175 P . O. Box 3539 j .AP�lAIR55 mfo cgpins . com __ Santa Rosa , CA 95402 INSURERL41AfFORDING COVERAGENA�C q _ INSURER A : O.regon MUtUaI Insurance Com.Tany _ 114907_ — — - INSURER s WCF National Insurance CampanY INSURED Service Station Systems, Inc. INSURER C -- 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 FO R THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN , THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT 70 ALL THE TERMS, EXCLUSIONS OF SUCH LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID _CH POLICIES. LCLAIMS. ONS AND CONDITIONS _ POLICY EFF POLICY EXP, _ IMIT3 ADDL SUBR 11, TYPE OF INSURANCE ))1`a2. POLICY NUMBER ,(ly)t,�fDDlYYYY] —` T INSR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE DAMAGE TO RENTED CLAIMS-MADE OCCUR1 MIS.L$_tEB 4diltNitiE ) — _ — — MED,EXP,jAny_one Iwtrsan)_- S PERSONAL E ADV_INJU_-V - - — � G_E_N_ERAL AGGREGATE - � $ GEN'L AGGREGATE LIMIT APPLIES PER; PRODUCTS . COMP/OPAGG 1 _ — LOC - POLICY ❑ ,1REi C $ OTHER: _ - ---" COMBINEDSINGLELIMIT 1 ,000,000 A AUTOMOBILE LIABILITY I t .LES fluad r�111 — ' CM0823523 1111512021 11116/2022 BODILY INJURY Perperson� s _ _ j X I ANY AUTO - - BODILY INJURY War accident S AO 0 ONLY I aG�yDEDULED ; I OPE'RTY (DAMAGE 4 — RE � �rewdenil X AUTOS ONLY j X . AUTOS OtY UMBRELLA LIAB OCCUR EACH OCCURRENCE _ { _. _ . .-- - i ` AGGREGATE, __ > EXCESS LIAB CLAIMS-MADE --- "- — - - - DED RETENTION $ X PER__ _ i OTH- B WORKERS COMPENSATION ! L12 t �'� AND EMPLOYERS' LIABILITY 046603 6/4/2022 ' 6/4/2023 E L, EACH ACCIDENT 100003000 ANY PROPRIETOR/PARTNERIEXECUTIVE Y� . NIA ' j 1 ,000, 000 OF FICERIMEMBE. }2EXCLUDED? IE. L_UISEASE • EAEMPLOYEf S - (Mandatory In ) 10000, 000 _— t1 yyes, de5Tni`Nunder PEE . LDISEASE • POLICY LIMIT $ DESCRIPTIONDFOPATIONSbelow _.__-- ------' DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES fACORD 101 . Addllloosl Remarks Schedule, may be attached N more apace In required) RE : Proof of Coverage _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 . AUTHORIZED REPRESENTATIVE 1988 -2015 ACORD CORPORATION . All rights reserved . ACORD 25 ( 2016103 ) The ACORD name and logo are registered marks of ACORD