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SERVSTA-01 ILICHAU <br /> CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) <br /> 6/6/2012 <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(ies)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 License#0603247 CONTACT <br /> George Petersen Insurance Agency,Inc. PHONE (800)236-9046 ac No:(888)579-2743 <br /> P.O.Box 3539 Arc No.Ext <br /> Santa Rosa,CA 95402 E-MAIL <br /> ADDRESS: <br /> INSURER(S)AFFORDING COVERAGE NAIC N <br /> INSURER A:ICW Group <br /> INSURED INSURER B: <br /> Service Station Systems,Inc. INSURER C <br /> 680 Quinn Ave INSURER D: <br /> San Jose,CA 95112 INSURER E: <br /> INSURER F <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 I sun <br /> LTR TYPE OF INSURANCE IN R WV POLICY NUMBER MMI DmYY MM/DDmYY LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ <br /> COMMERCIAL GENERAL LIABILITY A <br /> PREMISES Ea occurrence $ <br /> CLAIMS-MADE �OCCUR MED EXP(Any one person) $ <br /> 11: PERSONAL&ADV INJURY $ <br /> GENERAL AGGREGATE $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ <br /> POLICY 7 PRO- LOC $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> Ea accident <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED <br /> AUTOS AUTOS BODILY INJURY(Per accident) $ <br /> HIREDAUTOS NON-OWNED PROPERTY DAMAGE <br /> AUTOS Per accident $ <br /> UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ <br /> EXCESS LIAR CLAIMS-MADE <br /> AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION 7DISEASE <br /> - OTH- <br /> AND EMPLOYERS'LIABILITY YfN RA ANYPROPRIETOR/PARTNER/EXECUTIVE PL502130700 6/4/2012 6/4/2013 DENT "$ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N/A(Mandatoryb Nnd EA EMPLOYEyes,describe underESCRIPTION OF OPERATIONS below OLICY LIMIT <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,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 /> Proof of Coverage THE EXPIRATION THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WI�DATE <br /> OLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD <br />