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OP ID:. <br />CERTIFICATE OF LIABILITY I INSURANCE DATE(lYYYY) <br />Q51161116f11 <br />THIS CERTIFICATE 15 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 terns and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />PRODUCER <br />Placer Insurance Agency <br />License #OC66701 <br />P. O. Box 619052 <br />Roseville, CA 95661-9052 <br />Jeff P. Dreyer <br />INSURED Filmer Construction, Inc. <br />4470 Yankee Hill Rd., Ste 200 <br />Rocklin, CA 95677 <br />6at4-1008 <br />916-784-81 <br />ers <br />AFFORDING <br />Co <br />M11 -1--i <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 />INS <br />TYPE OF INSURANCE <br />DLtCYN B <br />POLICY EFF <br />POUCYEXP <br />LIMIT'S <br />GENERAL LIABILITY <br />EACH OCCURRENCE $ 1,000,0® <br />JO <br />'PREMISES (Ea occurrence $ 300,O <br />AI <br />X COMMERCIAL GENERAL LIABILITY <br />®occuR <br />X <br />08239X433TIL11 <br />05AMMI <br />05101/12 <br />MED EXP Ian one parson, $ 10,00 <br />PERSONAL & ADV INJURY S 1,ODO,00 <br />GENERAL AGGREGATE $ 2,000,00 <br />I1,000,00 <br />GEN'L AGGREGATE LIMIT APPLIES PER <br />PRODUCTS - COMP/OP AGG $ 2,000,00 <br />PRO - <br />POLICY .ErT LOC <br />$ <br />B <br />AUTOMOBILE LIABILITY <br />X ANY AUTO <br />108239X433TCT11 <br />05101111 <br />05/01112 <br />COMBINED SINGLE LIMIT <br />(Ea ecGder!) $ <br />BODILY INJURY (Per persa1) IF <br />ALL OWNED AUTOS <br />BODILY INJURY (Per eCcidanl) S <br />SCHEDULED AUTOS <br />X HIRED AUTOS <br />PROPERTY DAMAGE $ <br />(Per occident) <br />IF <br />X NON•O'+NNED AUTOS <br />$ <br />UMBRELLA LIAS X <br />OCCUR <br />EACH OCCURRENCE $ 4,000,00 <br />AGGREGATE S 4,000,00 <br />C <br />X EXCESS LIAB <br />CLAIMS -MADE <br />BEfl67954501 <br />05/01111 <br />05/01/12 <br />DEDUCTIBLE <br />$ <br />X RETENTION <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETORIPARTNER/EXECUTIVE YIN <br />OFFICERAYEMEER EXCLUDED 2 ® <br />(Mandatory In NH) <br />N r A <br />UB8239X433TIL11 <br />05/01/11 <br />05/01/12 <br />X S H <br />EL EACH ACCIDENT g_..� 1,000,00 <br />E L DISEASE - EA EMPLOYEE $ 1,000,00 <br />If S, on under <br />TI <br />E.L. DISEASE -POLICY LIMIT 1 000 00 <br />D <br />Builders Risk <br />EC4 018026 <br />10101M0 <br />10101M1 <br />L 3,000,00 <br />E <br />Pollution L(ab <br />2380435004 <br />10101110 <br />10/01/11 <br />Limn 1,000,00 <br />OF OPERATIONS I LOCATIONS t VEHICLES (Attach ACORD 101, Additional Remarks Schedule. H more space Is required) <br />I Centers LLC & Pilot Flying J are hereby named as Additional <br />h regards to General Liability per CGD246 8105 and Auto Liability <br />16109 attached endorsements. All attachments included within this <br />;hall apply as required by written contract. ***This certificate <br />PILOTCI <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Plilot Corporation ACCORDANCE WITH THE POLICY PROVISIONS. <br />5508 Lonas Dr <br />Knoxville, TN 37919 AUTHORIZED REPRESENTATIVE <br />w <br />U 1988-2009 ACORD CORPORATION. All rights <br />ACORD 26 (2009709) TAMh6CORD name and logo are registered marks of AiOD <br />