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CER) iFICATE OF LIABILITY INSUdNCE <br />DATE (MMIDDNYYY) <br />6/8/2015 <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 pollcy(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 />PRODUCER wNAME:n ucI <br />George Petersen Insurance Agency, Inc. 'AIC , 707 525-4150 <br />P.O. Box 3539 I <br />Santa Rosa, CA 95402 1 ;oouess. info(a)_ppins.com <br />INSURED <br />Service Station Systems, Inc. <br />3224 Regional Parkway <br />Santa Rosa, CA 95403 <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMRFR- <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 />M <br />LTR <br />TYPE OF INSURANCE <br />IND <br />POLICYNUMBER <br />POLICY EFF <br />MMIDDIYYYYI <br />POLICY EXP <br />IMMIDDrrYYY1 <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE ❑ OCCUR <br />j ,�J �. <br />fl -7l <br />y_ <br />L <br />L{j <br />EACH OCCURRENCE $ <br />PREMISES Ee pcartanceI S <br />MED MP (Any me palm) S <br />PERSONAL S ADV INJURY S <br />GENL AGGREGATE LIMIT APPLIES PER: <br />POLICY ❑ JECT � LOC <br />GENERAL AGGREGATE $ <br />PRODUCTS -COMPIOP AGG <br />S <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />HIRED AUTOS NNSWNED <br />;=N <br />U L 02 <br />IRON <br />[ <br />015 <br />ENTA! <br />COMBINED SINGLE LIMIT $ <br />BODILY INJURY (Per persm) $ <br />BODILY INJURY (Pa ecddenl) $ <br />P�erOa dent AGE S <br />$ <br />UMBRELLA LIAB <br />EXCESS LIAR <br />OCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE $ <br />AGGREGATE S <br />DED I I RETENTIONS <br />S <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS* UABILITY YIN <br />ANY PROPRIETORIPARTNERIEXECUTIVE <br />OFFICERAAEMBER EXCLUDED? <br />If , dory N and <br />tt yes IPTI he OF O <br />DESCRIPTION OF OPERATIONS lreloa <br />MIA <br />L502130703 <br />0610412015 <br />06/04/2016 <br />R ON - <br />X STATUTE ER <br />E.L. EACH ACCIDENT S 1,000,000 <br />E.L. DISEASE - EA EMPLOY S 110001$$$000 <br />E.L. DISEASE - POLICY LIMIT y 1,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addh1cmal Remarks Schedule, may be aaeaM U mora apace N required) <br />*Proof of Coverage* <br />Insured's Copy <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHOIUMD \REPRESENTATIVE <br />01988-2014 ACORD CORPORATION_ All rinhh romrvnA <br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD <br />