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BZSER-1 OP ID : BB CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 02/26/19 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy( les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement (s). PRODUCER Phone : 916 -567-3233 NAME; CT McDowall & Keeney Ins Assoc Fax: 916-567-3155 PHONEt Arc No); 865 Howe Ave, Suite 200 N91 Sacramento, CA 95825 ADDRESS: Jane Allyn McDowall INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Admir'al Insurance Company 24856 INSURED BZ Service Station Maintenance INSURER B... Nationwide Mutual lnsiurance Co 23787 Inc INSURERC : National Liability & Fire ins 20052 P . 0. Box 933 West Sacramento, CA 95691 INSURER D INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCEADDL SU POLICY NUMBER MMIDD MM%�D1YYW Y EFF LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 11000,00 DAMAGE T15 RENTEIJ� A X COMMERCIAL GENERAL LIABILITY X X FEI-ECC=23429-02 02/15/19 02/15/20 PREMISES Ea occurrence $ 50200 CLAIMS-MADE 7 OCCUR MED EXP (Any one person) $ 5900 X Cont Pollution PERSONAL INJURY $ 1 ,000100 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 21000,00 X POLICY PRO- LOC $ AUTOMOBILE LIABILITY Ee aB'deAtSINGLE LIMIT S 11000,00 B X ANY AUTO X ACPBA3037670604 02/15/19 02/15/20 BODILY INJURY (Per. person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOHIRED SAUTOS AUTOS N AUTw WNED PROPERTY DAMAGE $ Per accident S UMBRELLA LIAS OCCUR EACH OCCURRENCE _ $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION X I WC STATU- OTH- AND EMPLOYERS' LIABILITY ER C ANY PROPRIETOR/PARTNERIEXECUTIVE YINN lA X 9WC921126 10/27/18 .10/27119 E.L. EACH ACCIDENT $ _ 11000,00 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) EL. DISEASE - EAEMPLOYEE $ 11000,00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 11000,00 A Prof Liability FEI-ECC•23429-02 02115/19 02/15/20 Aggregate 21000,00 Each 12000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Sysco Corporation , its Subsidiaries , Affiliates & Divisions are named as Additional Insured , per written contract per attached CG 20 37 07 04 and Waiver of Subrogation applies per ECC- 320 - 07129 Waiver of Subrogation . for Comm Auto per AC 70 05 03 16 . Waiver of Subrogation for Workers Comp per WC 04 03 06 . CERTIFICATE HOLDER CANCELLATION SYSCO4 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Sysco Corporation THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y P ACCORDANCE WITH THE POLICY PROVISIONS. Insurance Compliance PO BOX 100085- CY AUTHORIZED REPRESENTATIVE Duluth, GA 30096 © 1988.2010 ACORD CORPORATION. All rights reserved . ACORD 26 (2010105) The ACORD name and logo are registered marks of ACORD