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SERVSTAaGL TT <br /> A CERTIFICATE OF LIABILITY INSURANCE F <br /> ATE (MM/DDIYY� Y1 <br /> 811124022 <br /> RINI THIS CERTIFICATE IS ISSUED AS A, MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIF1 CATE 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 INSUi2ER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the poiicypes) must have ADDITIONAL INSURED provias>; Ions or be endorsed. <br /> if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain poliCIGS may require an endorsement. A statement on <br /> this certificate does not confer rights to the certificate holder in Neu of such. endorsemen s Ran <br /> PRODUCER <br /> George Peterson insurance Agency, Inc. <br /> PHONE Fax 5254175 <br /> P.D. ge 3539 No, EYt : (707) 52'5.4150 ��A/ct Int0):(707 _. _ <br /> Santa Rasa, 9 95402 . )nfoalfpins.com <br /> �� ._ <br /> URER COVERAGE _. NAIC N <br /> wsuRERA C)recton Mutual Insurance COmnari _ 14907 <br /> — - 1490 <br /> INSURED �NVRER a,:WCF NationalCO <br /> , Insurance mlaany , <br /> Service Station Systems, Inc. INSURER C : <br /> 3224 Regional Parkway INSURER D <br /> Santa Rosa, CA 95403 INSURER E : <br /> INSURER F : <br /> COVERAGES CERTIFICATE NUMBEk: op 11 REVISION NUML39ft : <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, TERRA OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO VVHICH 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 TYPELOF INSURANCE ADDL UBR POLICY NUMB POLY EPPY1 MO <br /> ... EXP LIMITS <br /> fNso <br /> COMMERCIAL GENERAL LIABILITY EAC OCCURRENCE <br /> IIIIIIINI CLAIMS&MADEOCCUR DAMAGEtA �aENTED <br /> MEDEXP An one rsc f <br /> .PER BADVINJURY f _� <br /> G AGGREGATE pLRIMpIT. APPLIES PER: <br /> PRODUCGENERAL AGGRE +ATE <br /> POLICY ❑ ,QCT [71 LOC TS - PqP AQ f <br /> OTHER: COMl31NED SINGLE LIMIT <br /> 1 ,000,00 <br /> TO <br /> A AUTOMOBILE uAsILITY <br /> X ANY AUTO CM0923523 11/1512021 1111 1112022 BODILY MIJURY n ; <br /> WNED SCHEDULED BODILY INJURY dentj <br /> Oxli .f <br /> OOF40E ONLY AUpTNOpSy���p OPE <br /> X AUTOS ONLY X AUTOS ONLY r _f <br /> UMBRELLA tfAB EACH OCCUR NCE <br /> EXCESS LIAR CLAIMS-MADE AGGREGATE 3 <br /> DED RETENTIONS <br /> B woRKERS COMPENSATION <br /> AND EMPLOYERS' LIABILITY YIN 6603 614/2022 614/20231 ,000,000 <br /> ANY PROPRIETOWPARTNERIEXECUTIVE E.LFACHACCIDENI' S . _. _, ._. <br /> FI ER/M R <br /> EXCLUDED? N / A 1 ,000,000 <br /> E.LDIS EASE - EA, MPLOYE <br /> fl yes ductibew0sr E.L. DISEASE - POLICY LiM1T f 1 ,0002000 <br /> DESCRIPTION OFD aRAT10NS below <br /> i <br /> 1 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES {ACORD 101, AddIllonal Remad,a Schodula, may be attached H more apace W requhad) <br /> RE: Proof of Coverage <br /> CERTIFICATE HOLDER CANCELLATION FRI <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED �\REPRESENTATIVE <br /> ACORD 25 (2016103) © 19884015 ACORD CORPORATION, All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />