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SERVSTA-01 HFAHY <br /> A�oRn►• CERTIFICATE OF LIABILITY INSURANCE 76/2MIDDNYYY)M <br /> 4/2013 <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 CONTACT <br /> George Petersen Insurance Agency,Inc. PHONE g00 236-9046 4331 Fax <br /> P.O.Box 3539 A/c No Ext:( ) A.IC No)-.(707)525-4175 <br /> Santa Rosa,CA 95402 E-MAIL <br /> ADDRESS: <br /> INSURER(S)AFFORDING COVERAGE NAIC M <br /> INSURER A:Insurance Company of the West <br /> INSURED INSURER B: <br /> Service Station Systems,Inc. INSURER C: <br /> 3224 Regional Parkway INSURER 0: <br /> Santa Rosa,CA 95403 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 /> ILT R TYPE OF INSURANCE POLICY EFF POLICY EXP <br /> LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS <br /> GENERAL LIABILITY <br /> EACH OCCURRENCE $ <br /> COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ <br /> CLAIMS-MADE 1-1 OCCUR MED EXP(Any one person) $ <br /> PERSONAL 8 ADV INJURY $ <br /> GENERAL AGGREGATE $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ <br /> POLICY PRO- LOC $ <br /> AUTOMOBILE LIABILITY C MBINED SINGLE LIMIT <br /> Me accident <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED <br /> AUTOS AUTOS BODILY INJURY(Per accident) $ <br /> NON-OWNED PROPERTY DAMAGE <br /> HIRED AUTOS AUTOS Per accident $ <br /> UMBRELLA LIABOCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB HCLAIMS-MADE <br /> AGGREGATE $ <br /> DED I I RETENTION$ $ <br /> WORKERS COMPENSATIONWC STATU- OTH- <br /> AND EMPLOYERS'LIABILITY Y/N X T RY LIMIT ER <br /> A ANY <br /> OFFICER/MEMBER R EXCLUDED?ECUTIVE El N/A WPL502130701 614/2013 61412014 E.L.EACH ACCIDENT $ 11000100 <br /> (Mandatory in NH) E.L.DISEASE•EA EMPLOYE $ 11000100 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 1,000,00 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS I 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 /> Insured's Copy THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> V"`• V U <br /> ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD <br />