Laserfiche WebLink
ACORd' SERVSTA•CL DWAT <br />CERTIFICATE OF LIABILITY INSURANCE DATEIMMAXaYYYYI <br />THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HO/LDER. 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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies <br />certificate holder In lieu may require an endorsement. A statement on this certificate does not confer rights to the <br />of such endorsement(a). <br />PRODUCER <br />CONTACT <br />George Petersen Insurance Agency, Inc. NAME: <br />P.O. Boa 3539 Nrc 11 ; (707) 5251150 <br />Santa Rosa, CA 95402 E-MAIL AIC No : (707) 5251176 <br />Ao0BES5o Info ins.com <br />INSURERS AFFORDING COVERAGE <br />WsuRERA:Inaurance Com an of the West x7 <br />AICIN <br />INSURED 27547 <br />INSURER B <br />Service Station Systema, Inc. INSURER C: <br />3224 Regional Parkway <br />Santa Rosa, CA 95403 INSURERD: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A OREVISION IVB FOR THE POLICY pER�O[ <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 SUBJECTTOTT THE TERMS, <br />THI, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />R <br />1,TYPE OF INSURANCE <br />COMMERCIAL GENERAL LIABILITY <br />MMNDNYYY <br />IIM%DphIyY <br />CLAIMS -MADE ❑ OCCUR <br />GEWL AGGREGATE LIMITAPPLIES PER: <br />RE <br />E[ <br />POLICY ❑ JECOT LOC <br />OTHER: <br />N <br />V 3 0 2 <br />C <br />16 <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />ALL ED AUTOS ED <br />ENVIRO <br />MENTA <br />HEAL <br />HIRED AUTOS AUTOSw1JE0 <br />D <br />PARTM <br />NT <br />UMBRELLA LIAB OCCUR <br />EXCESS LIAB CLAIMS -MADE <br />DED RETENTIONS <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />A YIN <br />ANY PROPMETORIPARTNERA'XECUTIVE <br />OFFICERIMEMBER EXCLUOEDi nN/A <br />IWne.,.....,� vu. <br />L 6021307 Od <br />0 6/0 412 01 6 OBM4/2017 <br />DESCRIPTION OF OPERATIONS ILOCATIONS I VEHICLES (ACORO 1a1, Aedlllenel Remehv Scheeule, maY h tllscMtl X more specs Iv requires) <br />tE: License #485184 <br />BODILY INJURY <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Contractor State License Board Workers Compensation Unit THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />PO Box 26000 ACCORDANCE WITH THE POLICY PROVISIONS. <br />Sacramento, CA 95826 <br />AUT1//HOO(��RR,,�'MED \REPRESENTATIVE <br />V `, V U <br />ACORD 25 (2014/01) The ACORD name and logo are registered Marks 2of ACORD D CORPORATION. All rights reserved. <br />