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Client#: 1047352 SERVISTAIO <br /> ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDY" <br /> t3109/2025 <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(les) must have ADDITIONAL INSURED provlsioris 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 E, ' Rhonda Scialpi <br /> USI Insurance Services NW CL1 r E — rAX <br /> { No,Fxtpt 503 224.8390 �C,No) 610 3fi2.8130 <br /> 825 NE Multnomah, Suite 1500 Pubic __. -- --- <br /> Portland, OR 97232 iLADDREss:- rhonda.sciaipl@usl.com <br /> 503 224.8390 INSURERS)AFFORDING COVERAGE NAIL 9 <br /> w_a _ <br /> INSURERA t insurance Company of the West 27847 <br /> INSURED INSURER 8, <br /> Service Station Systems, Inc. __ ------INSURER C <br /> 3224 Regional Parkway ---- <br /> INSURER D <br /> Santa Rosa, CA 95403 - — - <br /> INSURER E: <br /> INSURER F t j <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 /> INS AAgD' OR POUCY€FF p9t,ICCY El(P — <br /> LT Pi— <br /> TYPE It1SR 0� POLICY NUMBER iMMIDDMYYJ (MMlDDh�Yv LIMITS <br /> - COMMERCIAL GENERAL LIABILITY - - <br /> r t EACH OCCURRENCE $ <br /> �v - -- <br /> CLAIMS•MADE OCCUR ppp qq�gEE TT <br /> J ! � ,. i.RR�MI5ESaEsoNT��Dt� $ <br /> MED EXP(Any one person) $ <br /> PERSONAL&ADV INJURY $ <br /> GEN L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ <br /> PRO. <br /> POLICY JECT LOC PRODUCTS-COMPIOPAGG E$ <br /> OTHER: _ f $ <br /> — — # <br /> AUTOMOBILE LIABILITY COMBI ED SIN TLIMIT - <br /> Es accident i <br /> f ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED 1­1 SCHEDULED <br /> AUTOS ONLY AUTOS BODILY INJURY(Per accident) s <br /> i HIRED NON-OWNED PROPERTY DAMAGE <br /> AUTOS ONLY AUTOS ONLY {Per accident) <br /> U LERBMI A LIAR OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB � - - <br /> CLAIMS-MA AGGREGATE g <br /> DED l..-.._ RETENTION$ _- <br /> A WORKERS COMPENSATION WLV507827801 - 6/0412025106/04/2026XTeER OH <br /> N ---- -- <br /> Tit -- 1 <br /> AOFNFDIC ROIryEM ERPEAXCNpR/DE?XECIrrIVE❑ jN/A, E ! E.L.EACH ACCIDENT � $1,000,000 <br /> YIN ; <br /> IMandato In NH) E.L.DISEASE-EA EMPLOYEE $1 000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below ( E.L.DISEASE-POLICY LIMIT $1 r000,DOO <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additlonal Remarks Schedule,maybe attached It more space 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 /> AUTHORED 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 /> #S49577197IM49674723 BLKZP <br />