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SERVSTA -CL QWATTS <br /> CERTIFICATE OF LIABILITY INSURANCE FDATE (MMIDDMYYY) <br /> 6131 /2023 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDERI, 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(les) 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 endor>semenL A statement on <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement (s), <br /> PRODUCER License 10603247 WE CT <br /> George Petersen Insurance Agency, Inc. PHONE ) AIc wo : (707) 525.4175 <br /> P,O, Box 3539 " No Est : (707 525-4150 <br /> Santa Rosa, CA 95402 1 Info@gpins. com <br /> INSURER191j8IFFORDING COVggM NAIC d <br /> INS11R RA : Ore on Mutual Insurance SAMJMny 14907 <br /> INSURED 1uRERe : WCF Select Insura ce Com an <br /> Service Station Systems, Inc. INSURER C : <br /> 3224 Regional Parkway INSURER D : <br /> Santa Rosa, CA 95403 <br /> INSURER E : _ <br /> INSURER F : <br /> COVERAGES CERTIFICATE N MBER: i N NUE8 <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 REOUIREMENT, 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 SUBR POLICY NUMBER POLICY EFF POLICY EXP <br /> LIMITS <br /> COMMERCIAL GENERAL UABILITY EACH CCURRE C <br /> CLAIMS-MADE OCCUR AMAGEE ORENTED <br /> I� <br /> MEDEXPiAny one on >e <br /> .-PERSONAL ILA V INJURY <br /> ENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGR LTE <br /> S <br /> POLICY ❑ jPCOT' E] LOC PRODUCTS -COI AGG <br /> I OTHER: <br /> COMBINED SINGLE LIMIT 1 ,000, <br /> AUTOMOBILE LIABILITYALIABILITY # 000 <br /> X ANY AUTO CM02924704 11115/2022 11115/2023 BOOILyINjURyjp8TpwI I <br /> OWNED SCHEDULED -- <br /> AURTEO�S ONLY AUUTOSy�ED BODIL i RY Per accident <br /> AUTOS ONLY AUTO ONLY dtareeW AMAGE <br /> UMBRELLA LIAe _ OCCUR EACH OCCURRENCE _ <br /> EXCESS LIAe CLAIMS-MADE AGGREGATE <br /> DED F-TRETENTIONS <br /> B WORKERS COMPENSATION F'ER CTH. <br /> AND EMPLOYERS' uAe11% YIN 046603 6/4/2023 6/4/2024 <br /> ANY PROPRIETgOERqIPARTNER/EXECUTIVE u�l .L. A HAC ID NT 11000,000 <br /> DEF1nCdE=5MW) EXCLUDED? NIA 1 ,000,0D0 <br /> It E.L. DI EA E - E PL Y <br /> It yeeaeecribeunder 1 ,0000 <br /> DESCRIP7 NOF OPERATIONS below E.l. DISEASE - POLICY LIMIT 11000,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD iei , Additional Remarks Schedule, may be attached I mora space Is mqukedl <br /> RE: Proof of Coverage <br /> .CERTIFICATE R CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL 13E DELIVERED IN <br /> Service Station Systems, Inc. ACCORDANCE WITH THE POLICY PROVISIONS, <br /> 3224 Regional Parkway <br /> Santa Rosa, CA 95403 <br /> AUTHORIZED REPRESENTATIVE <br /> ACORD 25 (2016103 ) 01986-2015 ACORD CORPORATION , All rights reserved , <br /> The ACORD name and logo are registered marks of ACORD <br />