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Ha,vnr�?. %,c--r� ir,iy c yr L,IAOILI I Y INJUOP ID Cl <br />SERVIO1 1 06/10/09 <br />PRODUCER- THIS CERTIFICATE UED AS A MATTER OF INFORMATION <br />George Rafersen Ins Agency ONLY AND CONFERa RIGHTS UPON THE CERTIFICATE <br />P. O. Box 3539 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />627 College Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Santa Rosa CA 95402 <br />Phone: 707-525-4150 Fax: 707-525-4175 <br />Service Station Systems, Inc. <br />680 Quinn Avenue <br />San Jose CA 95112 <br />rK41]YIy:7eT`N�9 <br />INSURERS AFFORDING COVERAGE I NAIC # <br />INSURER & C re95 Insurance CO an <br />INSURER B: <br />INSURER C: <br />INSURER D: <br />INSURER E: <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY 13E ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, <br />INSR T3 <br />LTR <br />N91iD <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POUCEF C <br />DATE MMIDD/YY <br />p <br />DATE MMlODlYI <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE S <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE � OCCUR <br />PREMISES Ea ocarence $ <br />MED EXP (Any one person) S <br />PERSONAL B ADV INJURY S <br />GENERAL AGGREGATE s <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY n jE 0. LOC <br />PRODUCTS - COMP/OP AGG s <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />COMBINED SINGLE LIMIT S <br />(Ea accident) <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />BODILY INJURY S <br />(Per person) <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />BODILY INJURY <br />(Per accident) <br />PROPERTY DAMAGE s <br />(Per occldani) <br />GARAGE LIABILITY <br />AUTO ONLY - EA ACCIDENT s <br />ANY AUTO <br />HOTHER <br />THAN EA ACC s <br />AUTO ONLY; AGG S <br />EXCESBNMBRELLA LIABILITY <br />OCCUR r-1 CLAIMS MADE <br />EACH OCCURRENCE s <br />AGGREGATE $ <br />S <br />DEDUCTIBLE <br />E <br />RETENTION s <br />t <br />A <br />WORKERS COMPENSATION AND <br />EMPLOYERS' IETCPILITY <br />ANY PROPRIETORIPARTNERIEXECUTiVE <br />3310020636091 <br />06/04/09 <br />06/04/10 <br />X TORY LIMIrS ER <br />ELF-ACHACCIDENT 51000000 <br />OFFICERIMEMBER EXCLUDED] <br />If yes, describe under <br />SPE CI AL PROVISIONS below <br />E.1- DISEASE - EA EMPLOYEE 5 1000000 <br />EL. DISEASE -POLICY LIMIT S 1000D00 <br />I <br />OTHER <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />Proof of Coverage. <br />*Ten day notice of cancellation in the event of non payment of premium. <br />>,.r -r% t IriuA I c nut-.ucrt L:ANULLLATION <br />Proof of Coverage <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 80 SHALL <br />UIPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />REPRESENTATIVES, <br />rn,urtu ca Icuu Iruo/ ©ACORD CORPORATION 1988 <br />