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%� Client#: 1047352 SERVISTA10 <br />ACORD. CERTIFICATE OF LIABILITY INSURANCE <br />=DATEDIY <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} must have ADDITIONAL INSURED provisions or be endorse <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />It cartiflcate does not confer any rights to the certificate holder In Ileu of such endorsement(s)- <br />USI Insurance Services NW CL1 P"'a`E �"�" ��'�''" <br />I c, o, Extl 503 224.8380Jwc. No <br />610 <br />825 NE Multnomah, Suite 1500 [ �oDRess rhondascialpl@usl.com <br />Portland, OR 97232 <br />503 224.8390 _ INSURER(S) AFFORDING COVERAGE <br />INSURER A: Insurance Company of the West <br />INSURED INSURER 13; <br />Service Station Systems, Inc.---- ---- <br />3224 Regional Parkway INSURERC: <br />Santa Rosa, CA 95403 INSURER 0: <br />INSURER E <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 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 />iNsR _. __ _._._..— .. <br />LTR TYPE OF INSURANCE DDL UBR "'pO�j FO ----. - <br />���AAAA - <br />- NSR, yrvtt _ POLICY NUMBER IMW DfYY IMMlDDlwvvj LIMITS <br />__ 11 _—_ <br />COMMERCIAL GENERAL LIABILITY- <br />- - ) EACH OCCURRENCE $ <br />ipp//��t�qq REED <br />CLAIMS -MAGE OCCUR PRE.MIEST Ea occNTunencn' $ <br />MED EXP (An ane person) S <br />PERSONAL & ADV INJURYS <br />GE_N'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ <br />PRO- _ <br />POLICY JECT LOC PRODUCTS-COMP/OPAGG S w __ <br />OTHER <br />_ $ <br />AUTOMOBILE LIABILITY t0BI SINGLET M19— <br />� Ee accldant� <br />ANY AUTO <br />BODILY INJURY (Per person)$ <br />OWNED SCHEDULED <br />AUTOSONLY AUTOS I BODILY INJURY (Per awdent) S _ <br />HIRED NON•OWNED $ <br />AUTOS ONLY AUTOS ONLY perr axlden DAMAGE — <br />UMBRELLA LIAR <br />—{ OCCUR EACH OCCURRENCE S <br />p(CE3SLIAR CLAIMS -MADE. AGGREGATE g <br />OED RETENTIONS <br />WORKERS COMPENSATION $— ----.. <br />A WLV507821801 6/04/2025 06/04/202 X PT°rT"' <br />AND EMPLOYERS, Y/N, _ <br />ANY PROP RIETORIPARTNERfEXECUTIVE E.L. EACH $1 011 00000 <br />OFFICERIMEMBER EXCLUDED? a NIA <br />ACCIDENT - <br />(Mandatory In NH) EL. DISEASE - EA EMPLOYEE $1 000 000 <br />Ifyes, describe under i <br />_,_ DESCRIP71pN OF OPERATIONS below E.L. DISEASE - POLICY LIMIT I $1 000 000 <br />i <br />DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space Is requlmd) <br />A waiver of subrogation applies where required by written contact . <br />CERTIFICATE HeLeFR ....,,.. ..,,... <br />Service Station Systems, Inc. <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />3224 Reglonat Parkway ACCORDANCE Wn'N THE POLICY PROVISIONS, <br />Santa out CA 85403 <br />AUTHORIZED REPRESENTATIVE <br />ACORD 25 (2016/03) 1 of 1 <br />#54857T18T/M495T4T23 <br />� 1988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />BLiSZP <br />