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BRTSE-2 OP ID:NP <br /> CERTIFICATE OF LIABILITY INSURANCE °"'EIM"°°"Y" <br /> _ 08117111 <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(ies) must be endorsed- If SUBROGATION IS WAIVED,subject to <br /> the terms and conditions of the policy, contain policies may require an endorsement. A statement on this certificate does not confer rights to Cho <br /> certIfIcAe holder in llau of such endorsement(s). <br /> PRODUCER 805543.6887 NAMEPOT_Nonna Jean <br /> Morris&Garritano Insurance ------- <br /> PNONE F11Xw - -- <br /> ApaneyLlunaes09055ea 606543-3064 MAIL <br /> LExt-368 <br /> PO Drawer 1189 EfB9AlE9f1 npere!&Morriagardtano.com <br /> San LuicO1189 CA 994tl8-1189 - - --_---- <br /> NSURERMIAPPONDai000VERADE <br /> ____—_ INSURER A:Everest National <br /> INSURED BdT ServlGe StsllOn DOOLrattOf INSURER a:Amco Insurance Co. 1619D <br /> dba:KC Partners Corp <br /> 890 S.Frontage Road - INSURERC: <br /> Nlpomo,CA 99444 INSURER D: <br /> INSURER F: _ <br /> mum F: <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS I'TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NO 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 /> NSR TYPE Di INSURANCE AIM POLICY NUMBER LICYlkF -POLICY ---- <br /> LTR ( 0 Y LIMITS <br /> ECIE.,MAGGRA <br /> LIANLItt EACH OCCURRENC! i _ <br /> ERCIALCENERALLMBILITY <br /> PREMISES ISM Tw�mnu f _ <br /> LAIMS.MADE O OCCUR MEDEXP(AnPoniIP0MMj f <br /> PERSONAL a ADV INJURY f <br /> GENERAL AGGREGATE i <br /> AGGREGATE?L�II�aTAPPLIE3 PER' PnOOUCTSCOMPIOP AGG fYJ—J.,R.t.L LOC S <br /> LE LUIBIUTY ELIMITUTO X 08115111 08/15112 BODILYYIINJU Y(Par pereon f1.000,00CPTUITZ»rr LLOWNED SCHEDULEDBCDRYINJURY(PraWMnn f <br /> NCN OWNED AU70S AUTOS P...w".lfLLALIAB OCCUR EACH OCCURRENCE f <br /> S LMB CuMMS•MADE AGGREGATE�RETENT f f <br /> WORKERS COMPENSATION I WCSTATU0T <br /> AND EMPLOYERS'UARILITY X MIS., PR <br /> A ANYPROPRIETORIPARTNERn:XECUTIVEY/N 7600003222111 08115111 08115112 E.I.AACHACCIDENT f 1,000,00 <br /> OFFICERAIEMBER EXCLUDED'I NIA <br /> (M r,"Imin Nlq <br /> E.L DISEASE-EA EMPLOYE S 1,000,00 <br /> B u.M T100 On0er <br /> DESCRIPTION OFOPER4TION5 below __ E.L OISEASE•POLICY LNdn f 1.000,00 <br /> r: <br /> notallatlonFloate CP7RiII»77 00/16111 08/16/12 1,0000edt 350,00 - <br /> g .uERNIPm/M ACPi142727977 08115111 08116112 1,000Dedt 100,00 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Mlach ACORD 151,AIhIldwal nsmarlM S d.14,Rmen s0sw'M rs,I1.0 <br /> Certificate Holder is additional Insured as respects Auto liability and <br /> Waiver of Subrogation per form AC2404B. <br /> I^„ <br /> CERTIFICATE HOLDER CANCELLATION <br /> TESOROR <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN <br /> Tesoro Refining ACCORDANCE WITH THE POLICY PROVISIONS. <br /> c/o PICS <br /> PO Box 61397 AUTHORIZED REPRESEN <br /> TATIVE <br /> Irvine,CA 92618 <br /> ®1968.220-.10 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD <br />