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A�� R CERTIFICATESERVSTA-01 ILt <br />OF LIABILITY INSURANCE F <br />_DATE (MMIDD/Y <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER'T <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED E THE POLIO <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORQ <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the Certificate holder Is anADD <br />Certificate holder in IJOU ITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, sub)ecl <br />the bans and con the policy, certain policies may require on endorsement. A statement on this certificate does not confer rights to <br />Iku of of such <br />such endorsement(s). <br />PRODUCER License IF 0603247 <br />George Petersen Insurance Agency, Inc. NAMEA T <br />P.O. Boz 3539 SONE(800) 236-9046 <br />Santa Rosa, CA 95402 E F.11000) 2365-9046 No): (888) 579-274 <br />INSURED <br />Service Station Systema, Inc. <br />600 Quinn Ave <br />San Jose, CA 95112 <br />A :ICW <br />VVCKAl7ts CERTIFICATE NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NIAMED A UVE FOR <br />THE POLICY PERIO <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THI; <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 />k TYPE Of INSURANCE <br />GENERAL LIABILITY <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE 17 OCCUR <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />AUTOMOBILE LIABILITY <br />URRENCE <br />ANY AUTO <br />Ee Occurrence <br />ALL OWNEDSCHEDULED <br />Any one person) <br />7GENERAL <br />AUTOS <br />AUTOS <br />HIRED AUTOS <br />NON -OWNED <br />AUTOS <br />UMBRELLA LIAR HOCCUR <br />EXCESS LIAR _ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />A ANY PROPRIETOR/PARTNERiEXECUTIVET[n <br />OFFICERMIEMBER EXCLUDED? <br />(Mandatory In NH) <br />K Vas. dascr&­", <br />LIMITS <br />URRENCE <br />S <br />Ee Occurrence <br />$ <br />Any one person) <br />7GENERAL <br />$ <br />& ADV INJURY <br />= <br />AGGREGATE <br />S-CObIP/OPAGG <br />S <br />_ <br />S <br />BODILY IWURY (Per person) $ <br />BODILY INJURY (Per eccltlent) $ <br />PROPERTY DAMAGE <br />Per accident S <br />$ <br />EACH OCCURRENCE $ <br />AGGREGATE e <br />130700 6/4/2012 6/4/2013R <br />EL. EACH ACCIDENT $ 1,000,00C <br />E.L. DISEASE - EA EMPLOYE $ 1,000,000 <br />E.L. DISEASE - POUCY OMIT S 11000.000 <br />DESCRIPTION OF OPERATIONS /LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) <br />'roof of coverage <br />CER <br />TION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Proof of Coverage THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />ACORD 25 (1010/05) The ACORD name and logo are registered Marks2010 ACORD CORPORATION. All rights reserved. <br />of ACORD <br />