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CERT�FlCQTE OF L[ABfLIT INSURahf+CE SERV-STA-CL sr pus <br /> THIS CERTIFICATE f5 ISSUED AS A A7ATTER "ATE(M `op CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND OR ALTER THE COVE <br /> OF INFORMATION ONIYAHD CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.1 <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE 6f3/201� <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. RAGE AFFORDED BY THE POLI( <br /> IMPORTANT: If the l:ertfficate haider ISSUING INSURER <br /> the terms and conditions of the policy,celtair�DDITfOkAL INSURED,the poli (S).AUTNORI7 <br /> ce rate holder in lieu of such endorsement(s)�alicies may require an endorsement. A stf�te►enent on hiaf Certificate G des IS WAIVED.RIVED,rights <br /> to <br /> George Petersen Insurance Agency,Inc. no(confer rights to <br /> PA.Box 3538 c Acr <br /> Santa Rosa,CA 95402 PHONE :(707)525-4450 FAx <br /> E A <br /> ADDAIC No:(707 525-417 <br /> aESS: <br /> 04SURED III$ ' S AFFORDING COVERAGE <br /> INSURER A:Insurance Cant Mn of the West *AIC I <br /> Service Station Systems,Inc, INSURER B: 27847 <br /> 3224 Regional Park"y INSURER C <br /> Santa Rosa,CA 85403 <br /> INSURER D <br /> INSURER E: <br /> COVERAGES CERTIFICATE NUMBER- <br /> P. INSURER F: <br /> 7HI5 IS TO CERTIFY THAT THE OLICIES OF INSURANCE LI5 <br /> INDICATED. NOIWITHSTgNDING ANY REQUIREMENT. TEb BELOW HAVE BEEN ISSUED TO TkE INSURED NrAMEp/6UpVHFR: <br /> CER1iFICATE MAY BE ISSUED OR MAY PERTAIN, THE IWSURAN <br /> E)(CLUSIONS AND CONpfTIONS Of SUCH POLICIES.LIMITS SHOWN CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH OR THE POLICY PERIOt <br /> Mrs CE AFFORDED BY THE POLICIES DESCRIBED MERMEN iS S <br /> MAY HAVE BEEN RESPI CT TO WI{(CH THI: <br /> TYPE OF INSURANCE REDUCED BY PAID CLAIMS. UBJECT TO ALL THE TERMS, <br /> COMMERCIAL GENERAL LIASILRI• POLICY NUMBER <br /> O M D <br /> CLAIMS-MADE []OCCUR LIMITS <br /> EACH OCCURfaENCE <br /> E. <br /> PREMISES Ea vcc t : <br /> GEML AGGREGATEMED EXP{Any-person) s <br /> LIMIT APPLIES PER <br /> POLICYPRO- PERSONAL INJURY ADV INJURY <br /> JECT LOC sGENERAL AGGREGATE <br /> OTHER: $ <br /> AUTOMOBILE LIAINOTY PRODUCTS-COMP,/OP AGG $ <br /> ANYAUTO s <br /> AOWNED �� em <br /> SULED Er dIN t <br /> AUTOS I HIRED AUTOS (Persan) ; <br /> AUTOS NON-OWNED BODILY INJURY pel <br /> BODILY INJURY(per mcc+denl <br /> PROPERTY DAMAGE ) s <br /> UMBRELLALIAB Per accide"I s <br /> OCCUR <br /> EXCESS LIAR s <br /> CLAIMS-MADE EACH OCCURRENCE <br /> DIED RETENTION s f <br /> WORKERS COMPENSATION AGGREGATE s <br /> A AND EMPLOYERS,t.,ABIUTY <br /> ANY PROPRIETORIPARTNERrFJCECUTNF YIN <br /> QFFICER/MEMBER EXCLUDED? PL502130.7D2 S <br /> (Mar"Imyinmm) NIA 06f0</2D14 0&10<120i5 X STATUTE 0 H- <br /> Ifye s,describe under E.L.EACH ACCIDENT ER <br /> DESCRIPTIDNO_FOPERATIONSbe,. s 1,000,00 <br /> E.1.DISEASE-FA E14PLDYE 1 11000,00 <br /> E.L.DISEASE-POL)CY LIMIT s <br /> tfe1'600'00 <br /> DESCRIPTION#OPERTiONS1LOCATIDRE;U�nse M485REGER, <br /> OdlupnelRem*aSchMWemay6eachedNrnwe�P+eeIsreAWred) <br /> JUN 02 2015 <br /> CNVIRQNMENTAI, <br /> iJC:d''TI.!nt_o,11]-rhRehiT <br /> CERTIFICATE HOLDER <br /> CANCELLATION <br /> Contractor State License Board Workers Cony THE ULD ANY OF THE ABOVE <br /> PO Box 26000 Pensation Unit EXPIRATION DATE DESCRIBED POLICIES gE CANCELLED BEFORE <br /> Sacramento,CA 95026 ACCORDANCE WITH THE POLICY PROVIS ONS�E MILL 9E DELIVERED IN <br /> AUTHOpIZEO REPRESENTATfYE <br /> ACORD 25(2014101) ©1@88-2014 ACORD CORPORATION. <br /> The ACORD name a nd logo are registered marks of ACORD <br /> All rights reserved. <br />