Laserfiche WebLink
Client#: 1047352 SERVISTA10 <br /> ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIryYY) <br /> _THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RI s/oa/2o25 <br /> GHTS UPON THE CERTIFICATE HOLDER.THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED EtY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATNE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the Certificate holder Is an ADDITIONAL INSURED, the policy(fes)must have ADDITIONAL INSURED provisions or be endorsed. <br /> I f SUBROt3ATION IS WAIVED,sub)ect 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 endoreement(s). <br /> PRoOUCER Rhonda Scialp! <br /> U$I Insurance Services NW CL1 <br /> a Erct: 503 224.8390 <br /> 825 NE Multnomah, Suite 1500 <br /> Portland, OR 97232 AODRess: rhondascialplrfDusl.clam <br /> $03 224.8390 INSURERS)AFFORDING COVERAGE <br /> NAIc a <br /> d INSURED INSURER A. Insurance Company of the West 27847 <br /> _ <br /> Service Station Systems, Inc. INSURERS' — <br /> 3224 Regional Parkway INSURER C; <br /> Santa Rosa, CA 95403 INSURERD: <br /> INSURER E: <br /> MSURER 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 CONTRACT OR OTHER DOCUMENT WIT}{ RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJEGT TQ ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> LW TYPE OF INSURANCE SR I..� POLICY <br /> COMMERCIAL GENE _.fnY 1RIDD FRS <br /> E®AAL�C�HAAOECCURRRENCE <br /> CLAIMS4AADE OCCUR ROW E8 NTTED re S <br /> E <br /> MED EXP one Person) $ <br /> PERSONAL&ADV INJURY y <br /> GEN'L AGGREGATE LIMIT APPLIES PER: <br /> — i PRO GENERAL AGGREGATE 5 <br /> POLICY M JECT LOC PRODUCTS-COMP/OP AGG ; <br /> OTHER <br /> �.. <br /> AUTOMOBILELUIBILtTY <br /> + 1 seddent <br /> ANY AUTO BODILY INJURY(Per person) s <br /> AUT&SPONLY SCHEDULED <br /> N W <br /> HARED ON-OWNED BODILY INJURY(Par aceem) $ <br /> AUTOS ONLY AUTOS ONLY ROP R Ab4A <br /> 1Per accident <br /> S <br /> !� UMBRELLA LIAR u� OCCUR EACH OCCURRENCE � S <br /> EXCESS LIAR CLAIMS-MADE —" <br /> AGGREGATE _ S <br /> DED RETENTION$ <br /> A AND KERS EMPLOMS,UABILICOMPENSATION m T WLV607821801 6/04/2025 06/04/202 s <br /> AND EMPLOYERS'IJABILITY <br /> ANY PROPRIETORIPARTNggRIEXECUTIVE Y/N — <br /> DFFICERlMEMBER EXCLUDED7 D N/A t E.L.EACH ACCIDENT 81,000,D06 <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1 OQD 066 <br /> Nyes.dIPTIO'under <br /> DESCRIPTION OF OPERATIDNS below E.L.DISEASE-POLICY LIMIT $1 00Q 000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD iSt,Addklonat Remarks 9ehedWs,may M atlaotrad If more apses la requlnd) <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 /> AUTHORIXED REPRESENTATIVE <br /> 0 1988 2D15 ACORD CORPORATION.All rights reserved. <br /> ACORD 25 (2016103) 1 of 1 The ACORD name and logo are registered marks of ACORD <br /> #S4967719VM49674723 BLKZP <br />