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B&TSERV-02 PATRA02 <br />" F ' <br />CERTIFICATE OF LIABILITY INSURANCE <br />DATE (M MIDOIYYY`r) <br />8116/2016 <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 pollcy(iosj 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 License # 0305584 <br />Morris & Garritano Insurance Agency, Inc. <br />PO Drawer 1189 <br />San Luis Obispo, CA 93406 <br />NAME_ Norma Jean Perez <br />_ <br />PHONE 805 543-6857 366 W jnrc 805 543-3064 <br />C No E, ; ( ) <br />E-MAIL n erez mortis arritanO.com <br />AoogeSS, p g <br />INSURER($) AFFORDING COVERAGE MAIC N <br />Insurance Company_42587 <br />INSURED <br />KC Partners Corp dba: B&T Service Station Contractors.INSURERC:AGCS <br />630 S Frontage Road <br />Nipomo, CA 93444 <br />�INSURERA:Depositors <br />SuRERB-State Compensation Insurance Fund of California ;35076 <br />Marine Insurance SerVice <br />22837 <br />I INSURERO: <br />biNSURERE: <br />SURER F <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION <br />OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.4 <br />INSR'.. �SQBR"'____.. <br />I'. PMLICY1IFF U EXP LIMITS <br />LTR ; TYPE OF INSURANCE. FN D I wV0':. POLICY NUMBER <br />nL00- YWY '.(MM/DDfYYYYl <br />~ � COMMERCIAL GENERAL LIABILITY <br />i EACH OCCURRENCE f S <br />j <br />CLAIMS -MADE ��Rj OCCUR <br />PRE.A S"r_5„-.{_E-a_ocwrrencel <br />MED EXP (Any ore person) 5 <br />PERSON FL & POV INJURY S <br />GEN'L AGGREGATE LIMIT APPL+ESPER { <br />GENERAL AGGREGATE <br />POLICY PRO- LOG <br />PRODUCTS - C_CMPIOP AGG$ <br />_ JECT . ] <br />OTHER. <br />T —.-- <br />S <br />..... <br />AUTOMOBILE LIABILITY <br />.PIE N L LI A <br />_{E a acadent S 1,000,000 <br />, A X ! ANY AUTO ACP7882727977 <br />08/15/2016 08115/2017 BODILY INJURY (Per person) S <br />ALL OA'NED SCHEDULED <br />AUTOS AUTOS <br />- 1 BODILY INJURY (Per accidera) S <br />—{ NO -0'AhED,`HERR <br />HIRED AUTOS AUTOS` <br />AMAGE S <br />UMBRELLA UAB _ OCCUR .. <br />EACH OCCURRENCE_ <br />EXCESS LAB ~, CLAIMS -MADE <br />AGGREGATE <br />_ <br />Oi RETENTION $ <br />S <br />wORKERSCOMPENSATION <br />j AND EMPLOYERS' LIABILITY Y 1 N! I <br />B ANY PRCRRIE70+2PARTNEWEXECUTIVE90685282016 <br />PER <br />X I ( _ <br />STATUTE ER <br />08/1512016:0811512017 EL EACH ACCIDENT s 1,000, U <br />OFFICER. MEPA3 ER EXCLUDED? <br />(Mandatary in NH) L� N A <br />EL DISEASE -EA EMPLOYEE_5_ 1,000,0001 <br />Ifyyecerr s, descnba urj <br />DESS RIF rtt P1 OF C ERATIONS belay <br />. E L DISEASE POLICY LIMIT S 1,000,00 <br />_ <br />C Installatfon/Builder SML93068950 <br />08/1512016 08/15/2017,Deductible $1,000 440,000 <br />C Equipment Floater !SML93068950 <br />08115/2016 0811512017 Deductible $1,000 100,000 <br />DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is regaLr" . ... <br />Re: Proof of insurance. <br />i, <br />i <br />CERTIFICATE HOLDER __ _CANCELLATION " " °' <br />Issued for Information Only <br />SHOULD ANY OF THE ABOVE DESCRIBED OLWIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS, <br />AUTHORIZED REPRESENTATIVE <br />A 40 -�— <br />Q 1988-2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD <br />