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OP ID:C1 <br /> 14�oRto CERTIFICATE OF LIABILITY INSURANCE F <br /> GATE( rYYYY) <br /> 101/04!04110 <br /> THIS CERTIFICATE 1S 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: H the certificate holder is an ADDITIONAL INSURED,the policy(be) 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 certificate does not confer rights to the <br /> certificate holder In lieu of such endorsement(s). <br /> PRODUCER 707-525-4150 1 CONTACT <br /> George Petersen Ins Agency 707-525-4175 PHONE(AtCFAX <br /> P.O.Box 3539 - -- (A1C No)-, <br /> 627 College Avenue --- ---- --- <br /> Santa Rosa,CA 95402 .;ABLEM-1 <br /> nefla---vlAIL nlilay ';-_ —_ INSURE s AFFORDBIGCOVERAGE NAIC0 <br /> INSURED ADTe Maintenance,Inc. INSURER A:Insurance Comps Lry of tate west _ <br /> 3224 Regional Parkway INSURER a <br /> Santa Rosa,CA 95403 <br /> IN6LgtER C: <br /> INSURER D: w <br /> ' 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 /> IN3R 1 T TYPE OF INSURANCE <br /> POLICY NUMBER MMIDD/YYYY LIMITS <br /> GENERAL LIABILITY <br /> EACH OCCURRENCE S _ <br /> _ COMMERCIAL GENERAL LIABILITY <br /> IS Ea �rros S <br /> CLAIMS-WADE 7 OCCUR I MED EXP Any om peraon <br /> PERSONAL 6 ADV INJURY <br /> I G£NERALAGGREGATE� S <br /> I GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S <br /> 11-7 POLICY PRO• LOC — _-- <br /> AUTOMOBILE UABtLITY i(COMBINED SINGLE LIMIT <br /> ANY AUTO (Easockla <br /> rd) <br /> : <br /> I ALL OWNED AUTOS I I BODILY INJURY(Per person) S —W <br /> I SCHEDULED AUTOS I I BODILY INJURY(Per accident) S <br /> PROPERTY DAMAGE $ <br /> HIRED AUTOS (Per acaderd) <br /> NON-OWNED AUTOS I — —— S — <br /> I <br /> UMBRELLA LIAR <br /> OCCUR ( EACH OCCURRENCE <br /> EXCESSUAB CLAIMS:tk E I AGGREGATE S�-� <br /> DEDUCTIBLE S Y— <br /> RETENTION $ <br /> WORKERS COMPENSATION X WC STATU- 1 OTH- <br /> AND EMPLOYERS'LIABILITY Y/N ORY Llt�ll — A —___-- <br /> A ANY PROPRIETOR/PARTNER/EXECUTIVE �PL500060302 10/01/10 10/01/11 1 E.L EACH ACCIDENT S 1,000,00 <br /> OFFICERAr1EMBER EXCLUDED7 N/A -- <br /> irrss d�esa be under E.L.DISEASE-EA EMPLOYE S 1,DOO,00 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,0 <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS!VEHICLES (Attach ACORD 101,Additional Remarks Schedule,H mom space Is required) <br /> RE: License#312844 <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 AUTHORED REPRESENTATIVE <br /> Sacramento,CA 95828 <br /> ®1688-2009 ACORD CORPORATION. All rights reserved. <br /> ACORD 26(2009/09) The ACORD name and logo are reglstered marks of ACORD <br />