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®��yy Client#: 10/4i7352 ® SER/VIISTA10 <br /> ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYVi <br /> 6/09/2025 <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 /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(Ies) musthave ADDITIONAL INSURED provlslons orb 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 endorsement(s). <br /> PRODUCER <br /> USI Insurance Services NW CL1 AGE: Rhonda Scialpl <br /> c, o Ex1i:503 224.8390 _ _.�ac, Nol; 610 362.8130 _ <br /> 825 NE Multnomah, Suite 1500 ADDRESS: rhonda.sclalpi@usi.com <br /> Portland, OR 97232 <br /> 503 224-8390 INSURER(8)AFFORDING COVERAGE NAIL N <br /> INSURERA: Insurance Company of the West _ 27847 <br /> NSURED Service Station Systems, Inc. INSURER B---- --- — <br /> 3224 Regional Parkway INSURERC: <br /> Santa Rosa, CA 95403 INSURER D <br /> INSURERE: <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 NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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 /> NS .- - _-- _DDL$USR -- '^�-_ POLICY EF POgg <br /> EXP <br /> �TR TYPE OF INSURANCE INS_ WVD POLICY NUMBER_ __-- jM1tlD YYYY jMMmryl .�._.. LIMITS <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ <br /> pqI p�E 7O RENTED __. . ._` CLAIMS-MADE OCCUR I PRE�M'&ES{Eeoccunencct I <br /> _- MED EXP(Any one personL$ <br /> PERSONAL&ADV INJURY <br /> _GEN'L AGGREGATE PIRMR APPLIES PER: GENERAL AGGREGATE $ <br /> . POLICY JECT LOC PRODUCTS-COMP/OP AG, +.s <br /> OTHER <br /> -AUUTOMOBILE LIABILITY J—i Ea ec NFDD S NGLE�.IMIT-- t " - <br /> I ANY AUTO i BODILY INJURY(per person) $ <br /> f~ OWNED $AUTOS <br /> HEDt1LE6 BODILY INJURY(Per accident) s <br /> .__� AUTOS ONLYTOS I <br /> HIREbD N OWNED PROPERT DAMAGE — <br /> AIIr SONLY <br /> ONLY fperealdentr $UMBRELLA LIAROCCUR I EACH OCCURRENCEEI(CEBS LIAR CLAIMS-MADE I AGGREGATE $ <br /> _ DED RETENTION$ <br /> A WORKERS COMPENSATION WLV507821801 6/04/2025 06/04/202 X P R OTH- <br /> AND EMPLOYERS'LIABILITY ( �ER „_- <br /> ANYPROPRIETOR/PARTNERIEXECUTIVEY/N E.L.EACH ACCIDENT $1,000,000 <br /> OFFICERIMEMBER EXCLUDED? N N/A <br /> If I yes,deory In and E.L.DISEASE-EA EMPLOYEE s1.00O 000 <br /> DES RIPTIONunder E.L.DISEASE-POLICY LIMIT 61.000,000 <br /> DESCRIPTION OF OPERATIONS bstow I <br /> I <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addhlonal Remarks Schedule,may be attached If more apace Is required) <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 /> ®1988-20115 ACORD CORPORATION.All rights reserved. <br /> ACORD 25 (2016103) 1 of 1 The ACORD name and logo are registered marks of ACORD <br /> #S49577197/M49574723 BLKZP <br />