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ACORp' ABLEM-1 OF ID:S4 <br /> CERTIFICATE OF LIABILITY INSURANCE DATE(MM,DDPIYYY) <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATEHO9THIS13011 <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 /> ItheMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the III 1c (les)must be endorsed. If SUBROGATION IS WAIVED,subject to <br /> certificate <br /> 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 Ileu of such endorsement(s). <br /> PRODUCER 7074150 corv7Acr <br /> Georg -525 <br /> e Petersen Ins Agency NAME: <br /> P.O.BOx 3639 707-5254175 PHON p FAx <br /> 627 College Avenue EtnA L R.Egli- AIC Np: <br /> Santa Rosa,CA 95402 AOOREsa: <br /> Douglas Dilley INSURERISI AFFORDING COVERAGE <br /> NAIL p <br /> INSURERS•ICW GroupINSURE➢ Able Maintenance, Inc. <br /> 3224 Regional Parkway INSURERS: <br /> Santa Rosa,CA 95403 INSURERC: <br /> INSURER p: <br /> INSURERE; <br /> NSURER F <br /> COVERAGES CERTIFICATE NUMBER: RE VISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORPOLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY.REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT THE 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 /> IL TYPEOFINSURANCE POLICY NUMBER Po Po <br /> MMlpo LIMITS <br /> UA®LITY <br /> EACH OCCURRENCE S <br /> COMMERCIAL GENERAL LIABILRY PREMIE S Ee0c nw S <br /> CLAIMSAIADE ❑OCCUR MEDEXP(AM..persan $ <br /> PERSONAL d ADV INJURY S <br /> GENERALAGGREGATE E <br /> GFN'LAGGREGATE LMnAPPLIES PER: PRODUCTS-COMPIOPAGG S <br /> POLICY PRO- LOC 5 <br /> 3A�OS <br /> ILE LIABILITY COMBINED SINGLE LIMIT <br /> dan S <br /> AUTO BODILY INJURY(Par person) S <br /> WNED SCHEDULED <br /> NUN-0WNEb BODILY IWURY(Perv:ddW) S <br /> D AUTOS AUTOS Pretitlenl GE S <br /> S <br /> REIUAB OCCUREACH OCCURRENCE S <br /> SS UAB CLAIMS-MAGE AGGREGATE RETENTI NS S <br /> WORKERS COMPENSATION INC STATU- GTN <br /> AND EMPLOYERS'LIABILITY <br /> A ANYPRDPOFRCETURIETORPARCLUDEEO ECUTNE YQ NIA L600060303 10101/11 10101/12 EL EACH ACCIDENT E 1,000,00 <br /> Iry.,,d ryln NHl E.L DISEASE-EA EMPLOYE 5 1,000,00 <br /> Ifyaa,desul0n NHJ <br /> DESCRIPTION OF OPERATIONS We E.L DISEASE-POLICY LIMIT S 1,000,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Aftc ACORD 101,AddllinnalRnmOrhe Schedule,11 mom spac0 10 required) <br /> RE:License 4312844 <br /> Proof of Coverage <br /> CERTIFICATE HOLDER CANCELLATION <br /> CONDOM1 <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Contractors State License ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Board-Workers Comp Unit <br /> PO Box 26000 AUTNOgREO REPRESENTATIVE <br /> Sacramento,CA 95828 (maf 2 <br /> y, <br /> �,-�o ©1968-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD <br />