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AC® SERVI01 OP ID: <br /> `....- <br /> CERTIFICATE F LIABILITY INSURANCE DATEI"MIDDM' <br /> 06/03/11 <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 cartifkabe holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WANED,subject to <br /> the terms and conditions of the policy,certain porkies may require an endorsement A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endoreemen s. <br /> PRODUCWR 707-525-4150 <br /> George Petersen Ins Agency <br /> P.O.Box 3839 707-525.4175 PHONE <br /> 627 College Avenue -- <br /> Santa Rosa CA 96402 S. <br /> Douglas Onley #NE!!!!"j 8EEMNO COVERAGE _kw <br /> eSURER A:Travelers Pros Cas of America 25674 <br /> INSURED Service Station Systems,Inc. <br /> 3224 Regional Parkway Blooms: <br /> Santa Rosa,CA 95403 arswR c: <br /> c <br /> eSIRtER E <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 /> WSR1 <br /> LTK TYPE OF INSURANCE PO <br /> POLICY NUINBHR LIMITS <br /> GENERAL LIAtIIJ1Y <br /> EACH OCCURRENCE _is <br /> COMMERCIAL GENERAL LIAe1LI7Y ENI <br /> ice) Is ---� <br /> CLAIMS-MADE 0 OCCUR AA ED EXP( one peraw) s ~ <br /> PERSONAL I ADV INJURY f __ <br /> GENERAL AGGREGATE f <br /> Gwt.AGGREGATE LIMIT APPLIES PER: <br /> PRODUCTS-COMP/OP AGG IS <br /> POLICY El <br /> PRO- LOC f <br /> AUTOIYIOBB,F LIABILITY L LaAIT <br /> ANYAUTO BODILY#WRY(Perparswt) f <br /> ALL OWNED SCHEDULED <br /> AUTOS ONON-OH® BODILY INJURY(Para nt) s <br /> HIRFJ)AUTOS AUTOS R <br /> S <br /> UMBRELLA LIAR OCCUR f <br /> EXCESS UAB EACH OCCURRENCE i <br /> CIAeAS�MADE AGGREGATE f <br /> DIED RETENTMW. <br /> WORxERS C01WENf11TI0N f <br /> ANO EMPWYElS LNtaIUTY IN X TORY_LIMIrfi ER. <br /> Y1C STATU OTH- <br /> A <br /> [OFF�KBN�E(p l Y® NIA IUBOOUF2133 06/04/11 06/04/12 E. EACH ACCIDENT f 1.000.E <br /> fM under N E.L DISEASE-EA EMPLOYEE f 1,000, <br /> .-TION Of OPERATI S below E.E.DISEASE.POLICY LIMIT S 1,000. <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks fdndWa iP more space kc rayuined) <br /> Proof of Coverage. <br /> CERTIFICATE HOLDER CANCELLATION <br /> LACCORDANCE <br /> OULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> E EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Proof of Coverage WITHTHE POLICY P#WViSIONS. <br /> AUTHORMED REPRESENTATIVE <br /> ®1968.2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 26(2010/06) The ACORD name and logo are registered marks of ACORD <br />