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CER1 ILIABILITY1 P <br />DATE (MMIDDNYYY) <br />9/27/2013 <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(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 endorsement(s). <br />PRODUCER <br />George <br />P.O. Box Petersen Insurance Agency, Inc. <br />Santa Rosa, CA 95402 <br />CONTACT <br />NAME: <br />PHONE. -9046 4178 :(g00) 236 FAx <br />At Not: (707) 525-4175 <br />F -MAIL <br />ADDRESS: <br />INSURERS AFFORDING COVERAGE NAIC p <br />G22070800008 <br />INSURER A: Westchester Surplus Lines Insurance Co. <br />INSURED <br />INSURER B : Wausau Underwriters Insurance <br />Able Maintenance Inc. <br />INSURER C: American Fire & Casualty <br />3224 Regional Parkway <br />Santa Rosa, CA 95403 <br />INSURER D: State Compensation Ins. Fund <br />INSURER E <br />INSURER F <br />..Vvetvavca LaKIIrIGAIt NUmtstR: REVISION NUMBER: 1 <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 SEEN RFnticFn av celn CI Aiwz <br />INTR <br />TYPE OF INSURANCE <br />wVDPOLICY <br />NUMBER <br />MSIDD EFF <br />- --- -- ------- <br />MPOLICYM�' <br />LIMITS <br />AqX170011"lution <br />GENERAL LIABILITY <br />MERCIAL GENERAL LIABILITY <br />CLAIMS -MADE ® OCCUR <br />& Profess. <br />G22070800008 <br />10/11/2012 <br />10/11/2013 <br />EACH OCCURRENCE $ 5,000,0OI <br />PREMISES Ea occurrence $ 50,00( <br />MED EXP (Any one penton) $ 5,000 <br />PERSONAL & ADV INJURY $ 51000100( <br />GENERAL AGGREGATE $ 5,000,00C <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY X JFCIPRO Loc <br />PRODUCTS - COMP/OP AGG $ 51000100C <br />MOLD $ 1100010010 <br />B <br />AUTOMOBILE LIABILITY <br />X ANY AUTO <br />ALL OWNED SCHEDULED <br />ASJZ91459057013 <br />4/1/2013 <br />4/1/2014 <br />Ea BIINNE�D SINGLE LIMIT 1,000,000 <br />BODILY INJURY (Per person) $ <br />BODILY INJURY (Per accident) $ <br />AUTOS AUTOS <br />NON -OWNED <br />HIRED AUTOS AUTOS <br />PROPERTY DAMAGE <br />Per accident $ <br />(� <br />X <br />UMBRELLA LIAR <br />EXCESS LIAR <br />X <br />FCCUR <br />CLAIMS -MADE <br />EUA1455094511 <br />4/1/2013 <br />4/1/2014 <br />EACH OCCURRENCE $ 4,000,00 <br />AGGREGATE Is 4,000,00 <br />OED RETENTION <br />$ <br />D <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? El <br />N / A <br />9073219-13 <br />10/1/2013 <br />10/1/2014 <br />WC STATU- OTH- <br />X TORY I ER <br />E.L. EACH ACCIDENT $ 1,000,00 <br />IDESCRIPTION <br />(Mandatory in NH) <br />K es, describe under <br />OF OPERATIONS below <br />E.L. DISEASE - EA EMPLOYE $ 1,000,00 <br />E.L. DISEASE- POLICY LIMIT $ 1,000,00 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />Evidence of coverage <br />Evidence Of Coverage <br />ACORD 25 (2010105) <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />v 7moa-AU1U 14t UKU t;VKFUKAI IVN. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />