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AC RD' SERVI01 OF ID: C <br /> �- CERTIFICATE OF LIABILITY INSURANCE DAM <br /> 6103/1YYY"' <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 11:1 Ms)must be endorsed. If SUBROGATION IS WANED,subject to <br /> the terms and conditions of the policy,certain policies may require an endorsement A statement on this urtificats does not confer rights to the <br /> certificate holder In lieu of such endorsement(s). <br /> PRODUCER 707-5254150 m <br /> George Petersen Ins Agency NAME: <br /> P.O.Box 3539 707-525.4175 11+�EJ`— uc sol. '---' <br /> 627 College Avenue <br /> Santa Rosa CA 95402 ADDRESS: <br /> Douglas Wiley INSURERflI AFFOROINO COVERAGE _NMC0 _ <br /> INSURERA:TravelersPro Cas of America 25674 <br /> INSURED Service Station Systems, Inc. ----- --- - <br /> 3224 Regional Parkway nmuaER B`-- <br /> Santa Rosa,CA 95403 INSURER C:: <br /> MSVRERD:_ <br /> INSURER E <br /> 1 URE F: --�---- <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES UI 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 /> M5ft TYPE OF W6URANCE AObl "`-- <br /> POLICY NUMBER ,D ExP LRlffS <br /> GENERAL UM <br /> SACH OCCURRENCE S <br /> COMMERCIAL GENERAL LIABILITY -- <br /> P EYBF. ottaxrariu S <br /> CLAM15#IADE �OCCUR <br /> ---- PERSDNgLIADV INJURY S <br /> I GENERAL A000.EGATE { <br /> GENI AGGREGATE LIMn APPLIES PER: <br /> POLICY PRO LOC PRODUCTS-COMPNM AGG f <br /> AUTOMOBILE LIABILITY f <br /> I GONB ED NGLE UNIT <br /> ANY ANO }rriEaAl _ <br /> ALL OWNED SCHEDULED BODILY INJURY(Pmpapn) 6 <br /> AUTOS AUTOS BODILY INJURY(Per p=kfo!) 6 <br /> HIRED AUTOS p�Og � 'p'/�0 RTY — <br /> Pa rrcke 0 S <br /> VMBRcI l e LMB f <br /> OCCl1R EACH OCCURRENCE { <br /> ElCESS LIAB CLAIMSIAADE —. -- <br /> AGGREGATE { <br /> D D NETENTION! --- <br /> WORKERSCOMPENSATION f <br /> ANO EMPLAYER6'UABILRY x WC STATI} OTH- <br /> A OFFICERNHAB�ExQu0EED7 ECUT Y❑ 11A UB8054F2133 06104/11 O6I04112 E.L EACH ACCIDENT f 1,000,00 <br /> (MSneArory In NMJ <br /> q s,dppvap mdv E.L.DISEASE-EA EMPLOYEE f 1.000,00 <br /> DESCRIPTION OF OPERATIONS hAIPw E.L.DSFJSE POLICY LRAn f 1,000,0 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (Much ACORD ID1,Ad IonY RvmM SeNWuI�,Rmpre�ppce lr 1pHine) <br /> Proof of Coverage. <br /> CERTIFICATE HOLDER CANCELLATION <br /> TTHE <br /> ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> IRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Proof of Coverage NCE WITH THE POLICY PROVISIONS. <br /> REPRESENTATIVE <br /> ©19882010 ACORD CORPORATION. All rights reserved. <br /> ACORD 26(2010106) The ACORD name and logo are registered marks of ACORD <br />