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- —' �• • • �� >`If-1LIL1 1 1 IIVQUm-AR 't OP ID C1 DATEIMMIDD/YYYY) <br /> PRODUCER SERV'I01 06 03 08 <br /> George Petersen Ins Agency THIS-C£RTIFICAT SUED AS A MATTER OF INFORMATION <br /> P. 0. Box 353 9 <br /> ONLYAND CONE. �DAIGHTS UPON THECERTIFICATE <br /> HOLDER l'HIS'CERYIFICAT1cDOES NOT AMEND;-EXTEND OR <br /> 627 College Avenue ALTER-THE COVERAGE•AFFORDED_BYTIE-POLICIESBELOW, <br /> Santa Rosa CA 95402 <br /> Phone: 707-525-4150 Fax:707-525-4175 INSURERS AFFORDINGCOVERA13E <br /> INSURED NAIC N <br /> INSURER A ;reaa..'Insurance Ce an <br /> INSURE"; <br /> Service Station Systems, Inc. INSUIReR�c: <br /> 680 Quinn Avenue <br /> San Jose CA 95112 INBLIREM <br /> MSl9RERE: <br /> COVERAGES <br /> THE POLICIES OF INSURANCE LISTED-BELUW HAVE BEEN ISSUED TO THE INSURED NAMED ABGVEF.ORAWjpAL'{C'i?-ERIODyPIDICATED:NOTWR}ISTANpING <br /> ANY REQUIREMENT,TERM OR CONDITJON-OF ANY CONTRACT ORUTHER.D000MENT WITH RESPECT TO'WHICH'THS.GfFl�1FIC11TE MAY6E9 WITH T <br /> MAY PERTAIN;THE INSURANCEAFFORDED.BYTHEPOLICIESDESCRIBEDAIEREINISSUBJECT TO'ALLTHETERMS£)(CL'USIOH-ATE CONDITssUED DR <br /> SUCH <br /> POLICIES.AGGREGATE LIMITSSHOWNiAAYHAVE BEEN REDUCED BY PAID`CLAIMS. <br /> BI <br /> LTR NSR - TYPE OF INSURANCE POLICY NUMBEROAQE AUppgjE`SjDDAry V � <br /> GENERAL LIABILITY <br /> EA <br /> COMMERCIAL GENERAL LIABILITYgl?BQ41O�R �IL'E' S <br /> CLAIMS MADE 7 OCCUR PR S <br /> MElb�XPa(7�'9M�non) s <br /> PIE., NALA AQV.'INMY S <br /> ;AGGREGATE Li <br /> GEML AGGREGATE LIMIT APPLIES PER: G" <br /> POLICY JPC LOC PF[000a,COMPIDP AGG S <br /> AUTOMOBILE LIABILITY <br /> ANY AUTO COMBINED SINGLE LIMIT <br /> (El noidtnt) 1 <br /> ALL OWNED AUTOS <br /> SCHEDULED ALTOS BODILY INJURY <br /> (Per person) S <br /> HIRED AUTOS <br /> NON-OWNED AUTOS BODILY INJURY <br /> (Per sxidIaN) S <br /> PROPERTY DAMAGE <br /> (Per 1110:1deri) i <br /> GARAGE LIABILITY <br /> ANY AUTO AUTO ONLY.EA ACCIDENT S <br /> OTHER THAN EA ACC S <br /> AUTO ONLY: <br /> EXCEBBA/MBRELLA LIABILITY AGG S <br /> EACH OCCURRENCE $ <br /> OCCUR � CLA1M5 MADE <br /> AGGREGATE S <br /> DEDUCTIBLE S <br /> RETENTION L S <br /> WORKERS CD10ENSATION AND S <br /> EMAL'OYLRC'11AB0#y R T Y..dtM1.6 R <br /> A NYPROI4EJER/ XCUTIVE 3310020636081 <br /> 06/04/x8 06/04/09 E.LEAIHACGIDENTOFFIGER `1kCLVED9 S400 00 <br /> M .n:d..orfwa.a•l. E.L:OAtA&E-EA WYEE:3-DDAADO. <br /> 6R. PROVIBIONfi belowE.Ll) AEE.+'POt*CY.LBAIT! s s1D(30'>D.00 <br /> OTHER <br /> DESCRIPTION or OFERATIONB I LOCATIONS I VEHICLES/EXCL-USIONS AD DEpbY'ENDORE[JAENTy 6PEOAI:RROVISIONS" <br /> Re: License #485184 <br /> Evidence of Workers' Compensation Coverage. <br /> Ten Day Notice of Cancellation in the event of non-.payment of-premium. <br /> CERTIFICATE HOLDER CANCERATION <br /> SHOULDANYOF, HEABOVEDESCRIBEDPOLICI"EECANCELLEDVEFORETHEEXPIRAnON <br /> DATE'THERBGF;THE-MIUMI01NSURiftINLLENDEAVORTOWIIL 30* DAYIWRITTEN <br /> NOTICETD THE CERTIFICATE HOLDER NAMED TO TH E LEFT,BUT FAILURE Tp Do to SHALL <br /> Contractors State License Boar IMPOSIVO)OBGIOATION OR'LIABILMY OF ANY KIND UPON THE INSURER,ITS AGENTS OR <br /> PO Box 26000 MEFRBBBNTATIVES. <br /> Sacramento CA 95826 A TIVE <br /> ACORD 25(2001108) ®ACORD CORPORATION 1988 <br />