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SERVSTA-CL NWINTER <br /> ACRO CERRICATE OF LIABILITY INSANCE DATE(MIAIDD/YYYY) <br /> 8/8/2015 <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 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 endorsement(s). <br /> PRODUCER CONTACT <br /> NAME: <br /> George Petersen Insurance Agency,Inc. PHONE FAX <br /> P.O.Box 3539 N EXe: 707 525 4150 (A/C.No: 707 525-4175 <br /> Santa Rosa,CA 95402 nDortEes,Info@gpine.com <br /> INSURER(111)AFFORDING COVERAGE NAIC N <br /> INSURER A:Insurance Company of the West 27847 <br /> INSURED INSURERS: <br /> Service Station Systems,Inc. IINSURER C: <br /> 3224 Regional Parkway INSURERD: <br /> Santa Rosa,CA 95403 <br /> INSURERE: <br /> NSURERF: <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 AM 9M <br /> LTR TYPE OF INSURANCE IND POLICY NUMB ER MMNDYEFF MMNDYYYP LIMITS <br /> COMMERCIAL GENERAL LIABILITY <br /> EACH OCCURRENCE $ <br /> CLAIMS-MADE OCCUR PREMISES Me occurrence $ <br /> E <br /> MED EXP(Any one person) $ <br /> GENL AGGREGATE LIMIT APPLIES PER: <br /> E `� 1 GENERALAGGREPERSONAL& VGATERY $ <br /> POLICY D JEF LOC q PRODUCTS-COMP/OP AGO $ <br /> OTHER: O 2 201 $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> 1 Ea accident <br /> ANY AUTO GNVIR NME TAL. BODILY INJURY(Par person) $ <br /> ALL OWNED SCHEDULED <br /> AUTOS AUTOS �-cA'TL;'r040-"R hl- BODILY INJURY(Per accident) $ <br /> HIRED AUTOS AUTOS <br /> SWNED PR PERTY DAMA E $ <br /> Per accident <br /> $ <br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED I I RETENTION$ $ <br /> WORKERS COMPENSATION _ <br /> AND EMPLOYERS'LIABILITY X STATUTE ER <br /> YIN <br /> A ANY PROPRIETOR/PARTNER/EXECUIIVE PL502130703 08/04/2015 08/04/2018 E.LEACHACCIDENT <br /> OFFICER/MEMBER EXCLUDED? � NIA $ 1r000,OOO <br /> (Mandatory In NH) <br /> If E.L DISEASE-EA EMPLOY $ 1,000,000 yes,descrbe under <br /> DESCRIPTION OF OPERATIONS be]. Et DISEASE-POLICY LIMIT $ 1,000,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACCORD 101,Additional Remarks Schedule,may be attached If more space Is required) <br /> -Proof of Coverage` <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 /> AUTHORIZED\REPRESENTATIVE <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />