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NNW <br /> i---S SERVSTA-CL NWINTEF <br /> AC61812 <br /> CW" CERTIFICATE OF LIABILITY INSURANCE OATDI <br /> II 618120755 <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 be endorsed. If SUBROGATION IS WAIVED,subject to <br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> Certificate holder in lieu of such endorsements . <br /> CONTACT <br /> PRODUCER NAME: <br /> George Petersen Insurance Agency,Inc. PNONE (707)525-4150 (AX:.No1:(707)525 175 <br /> FAX <br /> P.O.BOX 3539 ,MAIse <br /> Santa Rosa,CA 95402 ADDRE S:Inf ins.com <br /> INSUR S AFFORDING COVERAGE NAIC0 <br /> INSURER A:Insurance Company of the West 27847 <br /> INSURED INSURER 9: <br /> Service Station Systems,Inc. INSURER C <br /> 3224 Regional Parkway W SURER D <br /> Santa Rosa,CA 95403 wSURERE: <br /> INSURER F: <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 /> 1as ____._.._..... -._ POLICY EFF P LICV <br /> LTR TYPE OF INBURANC! POLICYNUMBER MMIDO MMILIV V LIMITS <br /> COMMERCML GENERAL LIABILITY EACH OCCURRENCE $ <br /> CLAIMS-MADE ❑OCCUR PREMISES Ea occunence $ <br /> MED EXP(Any one person) E <br /> .—....... PERSONAL A ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: aAGGREGATEGGREGATE .S <br /> POLICY JECT LOC -COMPIOP AGG $OTHER: —� $AUTOMOBILE UARMUTy SINGLE LIMB ANY AUTO URY(Per parson) S <br /> ALL OWNED1 SCHEDULEDAUTOS AUTOS RY(Per&W"nU S <br /> HIRED AUTOS AUTOS O i S <br /> S <br /> Ia16RELlA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS UAB CLAIMS-MADE AGGREGATE $ <br /> OED RETENTIONS 1 $ <br /> WORKERS COMPENSATION X <br /> AND EMPLOYERS'LIABILITY STATUTE R <br /> YIN <br /> A ANY PROPRIETORIPARTNERVE CUTNE L502130703 0010412015 0010412010 E.L EACH ACCIDENT $ 1,000,000 <br /> OFFICEILI.EMBER EXCLUDED? F-1 MIA <br /> (1ey6B,6Ntnory In NH) E.L.DISEASE-EA EMPLOYEE S 1,000100 <br /> desDESCRIPTION OFOPERATIONS DaIov E.L DISEASE-POLICY <br /> .UNIT`T IV <br /> 11000,09 <br /> .aly]gi�' <br /> IL ■ ¢'D®E �" ; <br /> DESCRIPTION OF OPERATONS I LOCATIONS I VEHICLES(ACCRO 101,AJCNlonal Remame Scheoule,may be aKachw If mon apace Is"vI,Nt) <br /> *Proof of Coverage' JAN s1 1 9 20116 <br /> ENVIRONMENTAL <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Insured's Copy THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTH�OR"IUD REPRESENTATIVE <br /> ©1988.2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />