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Client#: 1047352 SERVISTA10 <br /> AC RDn, CERTIFICATE OF LIABILITY INSURANCE yDATE(MMIDDIY" <br /> - 6/08/2025 <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 /> IM TANT; If the certificate holder Is an ApDITIONAL INSURED, the policy(te3) must have ADDITIONAL IS SUftED 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 any rights to the certificate holder In lieu of such endarsement(s), <br /> PRODUCER <br /> USI insurance Services NW CL1 N E: Rhonda Scialpl <br /> 825 NE Multnomah, Suite 1500 ar$ Ho Est: 503 224�8390 i Portland, OR 97232 N,I; 610 362-8130 <br /> ADDRESS: rhonda.sclalpl@usi.com <br /> 503 224.8390 __ INSURER(B)AFFORDING COVERAGE NAIL k <br /> INSURER A: Insurance Company of the West 27047 <br /> INSURED INSURERS; <br /> Service Station Systems, Inc. -- <br /> 3224 Regional Parkway INSURER C: _ <br /> Santa Rosa, CA 95403 INSURERD: <br /> INSURER E <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 NAMEp 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 /> LNg <br /> TR TYPE OF INSURANCE VOL POLICY P <br /> _INSR POLICY NUMBER Aa.( UtY1tYY IAg LIMITS <br /> C MMERCIAL GENERAL LIABILITY EACH OCCURRENCE S <br /> CLAIMS-MADE OCCUR LJ=rr <br /> sotwrrencs' S <br /> MED EXP An one person $ <br /> —` PERSONAL 8 ADV INJURY <br /> GEM AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE L <br /> PRO- <br /> JECT LOC PRODUCTS-COMP/OP AGG <br /> POLICY I—] ; <br /> OTHER: <br /> AUTOMOBILE LIABILITY _ f Ea Fad M N L LIMIT __... <br /> ANY AUTO BODILY INJURY(Per parson) S <br /> OWNED SCHEDULED <br /> AU�T�0p8 ONLY AUTOS BODILY INJURY(Per accideni) S —� <br /> AUTOS ONLY AUTOS ONLY RDPERT AMAGE S <br /> Per aockram <br /> S <br /> — UMBRELLA LtAB <br /> OCCUR EACH OCCURRENCE S <br /> EXCESS LIAR CLAIMS-MADE AGGREGATE S <br /> - — <br /> OEDL_J RETENTIONS <br /> A WORKERS COMPENSATION WLV507821801 6104/2025 06/04/202 X PER m. <br /> AND EMPLOYERS'LIABILITY _ <br /> OFFIEWMEMSER EXCCLUDED�ECUTIVE Y® NIA E.L.EACH ACCIDENT $1 000 000 <br /> (Mandatory In NH) EL.DISEASE-EA EMPLOYEE S1 1000,000 <br /> If yes,desalbe under <br /> DESCRIPTION OF OPERATIONS below El.DISEASE-POLICY LIMIT 1$1 000 000 <br /> I <br /> DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES 1ACORD 101,Addltisnal Remarks Schedule,may be atWhod It mon space Is requlroo) <br /> A waiver of subrogation applies where required by written contact . <br /> CERTIFICATE HOLDER CANCELLATION <br /> Service Station Systems, Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> 3224 Regional Parkway ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Santa Rosa, CA 95403 <br /> AUTHORIZED REPRESENTATIVE <br /> ®19BB-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25 (2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD <br /> #849577197/M49574723 B LKZP <br />