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A rll A r�< <br />SERVSTA-01 ILICHAU <br />CERTIFICATE OF LIABILITY INSURANCE <br />°ATsIM/201 YYY, <br />LIABILITY <br />/s/2o1E 2 <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. IT 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 <br />George Petersen Insurance Agency, Inc. <br />P.O. Box 3539 <br />Santa Rosa, CA 95402 <br />CONT <br />NAME�CT <br />PHONE (800) 236-9046 uc Ne : (BBB) 579-2743 <br />A No San <br />E-MAIL <br />ADDRESS: <br />INSUREWSI AFFORDING COVERAGE NAIC0 <br />INSURER A: ICW GrOUP <br />INSURED <br />INSURER S: <br />Service Station Systems, Inc. <br />INSURER C: <br />680 Quinn Ave <br />San Jose, CA 95112 <br />INSURER D: <br />INSURER E : <br />INSURER F <br />rnUeewr_ec <br />- — - "' '-- -- -^--�• •• RCYIaIUK KUMCGK: <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 />INSRNdUCY —EFF <br />LTR TYPE OF INSURANCE POLICY NUMBERMMIDD NMIOUM-YY LIMITSGENERAL <br />LIABILITY <br />EACHOCCURRENCE $ <br />COMMERCIAL GENERAL UABWTY <br />CLAIMS -MADE ❑OCCUR <br />PREMISES Ea oxurtence E <br />MED UP (my one Penson) $ <br />PE RSONALSADVIWURY $ <br />GENERALAGGREGATE $ <br />GEN -L AGGREGATE UNIT LIES PER <br />POLICYFI PRO. LOC <br />PRODUCTS - COMPIOP AGG $ <br />S <br />AUTOMOBILE <br />LIABILITY <br />- <br />OMBINED SINGLE LIMIT <br />Ea accident <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />HIREDAUTOS NON -OWNED <br />AUTOS <br />BODILY INJURY (Per person) E <br />BODILY INJURY (Per accident) E <br />PROPERTY DAMAGE g <br />Per &=Went <br />LALIAB <br />UM1IRES <br />EXCESS LIAR <br />EXCESS <br />OCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE S <br />AGGREGATE $ <br />DED RETENTION$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITYX <br />ECIITIVE YIN <br />OFFICE"EMBER EXECLUDED ❑ <br />E <br />WC STATU- DTH. <br />A <br />NIA <br />PL502130700 <br />6/44/2012 <br />0/4/2013 <br />EL EACH ACCIDENT $ 11000,000 <br />(Mandatory In NH) <br />Myyree dosaiDe underOESGIRIPTION OF OPERATIONS bakw, <br />E.L. DISEASE - EA EMPLOYE $ 110001000 <br />EL DISEASE-POUCYUMR $ 1,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Aaach ACORD 101, Additional Remarks Schedule, if more space Is required) <br />Proof of coverage <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Proof of Coverage THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />(Fill = <br />1988.2010 ACORD CORPORATION. All rights reservad <br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD <br />