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SERV101 OP ID:C1 <br /> (MMJD <br /> CERTIFICATE F LIABILITY INSURANCE DATE 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 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 may require an endorsement A statement on this certificate does not confer rights to the <br /> certificate holder In lieu of such endorsements. <br /> PRODUCER 707525-415® CONTACT <br /> George Petersen Ins Agency "MR: <br /> P.O.Box 3639 707-525-4175 PHONE Ax <br /> 627 College Avenue <br /> Santa Rosa CA 95402 ADDRESS. --- --- <br /> Douglas Oflley INSURER(Sl 6FfOR9 NO COVERAGE <br /> _ _ INSURER A:Trn_veleta Prot)Cos of America 25674 <br /> INSURED Service Station Systems,Inc. � USURERa: LL <br /> 3224 Regional Parkway -- " <br /> Santa Rosa,CA 95403 USURER <br /> INS UREM D;_ <br /> INSURER E: <br /> I FIRER 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 /> 70ENEFRtAL <br /> TYPE OF INSURANCE 4 -� PfmurE — <br /> POLICY NUMBER LIMITS <br /> LIABILITY EACH OCCURRENCE $ <br /> MERCIAL GENERAL LIABILITY RE ES $ <br /> CLAIMS-MADE OCCUR AAED EXP(Arty one person) <br /> _ PERSONAL S ADV INJURY S —_ <br /> GENERAL AGGREGATEREGATE LOdn APPLIES PER: PRODUCTS-COMPIOP AGG SY PRO.JECT LOC S <br /> AUTOMOBILE LIABILITYOMS IN L LIMIT <br /> a xxidest I — S _ <br /> ANY AUTO <br /> BODILY INJURY(Per person) S <br /> ALL OWNED SCHEDULED <br /> AUTOS AUTOS BODILY tNJURY(Per ecddew) $ <br /> HIREDAUTOS AUTOS�� PCO _�— S <br /> s <br /> UMBRELLA LIAe <br /> JJJ <br /> _ <br /> HCLcAc,M,:,,A. <br /> E/4CH OCCURRENCE i <br /> EXCESS LIAB <br /> � yGGREGATE S --- <br /> D D RETENTION$ $ <br /> WORMERS COMPENSATION WC STATU 0TH <br /> AND EMPLOYERS'LIABILITY X <br /> A ANY PROPRIETORIPARTNEWCLECUTLYE IU <br /> B6054F2133 06104/11 06/04/12 E,L EACH ACCIDENT $ 11000,00 <br /> OFF�RIMEMSER EXCLUDED9 I A <br /> Ify sdatory M NH)urw E-L DISEASE-EA EMPLOYEE S 1,000, <br /> Iye 6.de6Ct�e under . <br /> DESCRIPTION OF OPERAT below <br /> E.L.DISEASE•POLICY LIMIT I$ 1,000,0011 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,N mora space Is required) <br /> Proof of Coverage. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREQF, NOTICE WILL BE DELIVERED IN <br /> Proof of Coverage ACCORDANCE WITH THE POLICY PROV(SIONS. <br /> AUTHORUED REPRESENTATIVE <br /> ®1986-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 26(2010105) The ACORD name and logo are registered marks of ACORD <br />