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Client#: 1047352 SERVISTA10 <br />ACORD. CERTIFICATE OF LIABILITY INSURANCEDA• E(MMIDDY <br />6109/2025 <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 />ImMOK IAN 1: Jr Lne CBrtInCa[e nOlOer IS an ADUI I ZONAL INSURkD, the poncYllesj must nave 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 endorsement. A statement on <br />this certificate does not confer any rights to the certificate holder In lieu of such endorsement(s), <br />PRODUCER TO <br />E, _Rhonda Scialpi <br />USI Insurance Services NW CLI E <br />Ext!; 503 224.8390Vic, N,) 610 3624130 <br />825 NE Multnomah, Suite 1500 �a 6 No _ --- <br />Portland, OR 87232 ,ADDRESS:- rhonda.sciaipl@usJ com <br />Po land,224m8R INSURERS) AFFORDING COVERAGE NAIL 0 <br />w_a <br />INSURER Insurance Company of the West 27847 <br />INSURED.....,M_. ._._m_.. ,.. ,..�_.______,•,_.__..__ <br />Service <br />Station Systems, Inc. �=---••-•� - • _ .__ __ _ ___ __._. _. <br />3224 Regional Parkway INSURER C -- _ <br />INSURERD <br />Santa Rosa, CA 95403 — <br />INSURER E <br />CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS IS 70 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 />---- <br />LTI} TYPE OF INSURANCE Iiuw ` v p: � POLICY NUMBER IMMIDDNYri'a.. (MM�O�i�Yv LI <br />MITS <br />COMMERCIAL GENERAL LIABILITY FCH OCCURRENCE <br />pA$ <br />-� CLAIMS -MADE OCCUR ( i PAF1 %1 %J? o�TTFD $ <br />MED EXns $o <br />_ PERSONAL & ADV INJURY S <br />GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ <br />PRO - <br />POLICY " JECT LOC PRODUCTS -COMPIOPAGG E S_ <br />OTHER j $ <br />AUTOMOBILE LIABILITY COMBI ED SINL LIMIT <br />Ea aoddem i <br />f ANY AUTO j BODILY INJURY (Per penton) IS <br />OWNED I— SCHEDULED BODILY INJURY (Per accident) $ <br />AUTOS ONLY AUTOS <br />HIRED NON*OWNED PROPERTYDAMAGE <br />AUTOS ONLY AUTOS ONLY {Per accldent _ _ $ <br />_ r$ <br />-� <br />UMBRELLA LA LIAR OCCUR EACH OCCURRENCE $ <br />EXCESS ,IAB -- <br />CLAIMS MADE AGGREGATE g <br />DED RETENTION <br />A WORKERS COMPENSATION WLV507821801 6/0412025,06/04/2026 X TPER OTH-, <br />AND EMPLOYERS' LULBR.ITY Yf N ,SLUE—.�I{ <br />ANY PROPRIETORIPARTNERIEXECUTIVE j E.L. EACH ACCIDENT $1 <br />OFFICERIMEMBER EXCLUDED? N 1 A E <br />(Mandatory In NH) E.L. DISEASE • PA EMPLOYEEIf } $1 <br />DESCRbe under <br />IPTION OF OPERATIONS belay ( E.L. DISEASE -POLICY LIMIT 157 <br />DESCRIPTION OF OPERATION91 LOCATIONS /VEHICLES (ACORD 101, Additional Ramarhe Schedule, may be ariached if more apace le requlrod) <br />A waiver of subrogation applies where required by written contact . <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 PROVIS{ONS. <br />Santa Rosa, CA 95403 <br />AUTHOREZED REPRESENTATIVE <br />01988-2015 ACORD CORPORATION. All rights reserved, <br />ACORD 25 (2016103) 1 of 1 The ACORD name and logo are registered marks of ACORD <br />#S4957T197IM49674723 BLKZp <br />