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ABLEMAI -CL DWATT8 <br /> DATE INMIDDIYYYY) <br /> � 1 <br /> A RQ� CERTIFICATE OF LIABILITY INSURANCE 101.812021 <br /> THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> BELOW. <br /> CERTIFICATE <br /> CERTIFICATE CATEFOF INSURANCE DOES NOT CONSTITUTE VELY OR NEGATIVELY , XAECONTRACT BETWEENND OR ALTER THE THE ISSUING INSURER(j AUTHORIZED <br /> BELOW. - . . <br /> REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br /> 9 --- — <br /> Da the <br /> CY( IOS) must have <br /> 1 IMPORT NT9It IS WAIVED, holder Is tonthe terms andloo conditions of the 1policy, certaln policies ADDITIONAL <br /> require an enndoSURED rrsemant. A statement on <br /> If SUBROGATION - --- -- -- ""� �.-. <br /> this certificate does not confer rights to the certificate holder I� n lino Of �ndc rsDment(s). – <br /> ttBM , _ . ._.. . . ... FAX <br /> PRODUCER PHONEEzt : (707) 525.4150 . . I (AIC, No):(70715254176 .:,_.. <br /> Geerge Petersen Insurance Agency, Inc. info pins Com <br /> RO , Box 3539 g 4)3 55 __ _ -• <br /> Sante Rosa , CA 96402 INSURER)S� AFFORDING COVERAGE <br /> tNsuRERA; HomelaIt Insurance Com "_°f Now York X34452 <br /> --- . .— — — wsunERB : WestAmerican_Insurance .Company 4+1383 <br /> INSUREDINSURERC : StaIt <br /> te Compeneation Insurance Fund <br /> Able Maintenance Inc. <br /> Able Regional Parkway INSURER D : American Flre & Casual Company 424066 <br /> { <br /> 1 Santa Rosa, CA 95403 INsuR�„•,._„ERE: <br /> I I INSURER_F : _ �_.•_ - <br /> _ �- <br /> REVISION NUMBER: <br /> —» - CERTIFICATE NUMBER: <br /> COVERAGES _ E BEEN ISUED TO THE BELWKAV <br /> THIS IS TO CERTIFY T AT THE POLICIES I <br /> ANDING ANY RE UOF INSURANCE IREMENTTERMICY PEIOD <br /> IORDCONOIOTON OF ANY OSNTRACTOROITHERDOCUMENTWITHRESPECTTOLWHICH7HIS <br /> INDICATED. NOTWITHSTANDING <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES' MTS SHOWCERTIFICATE MAY BEN MAY HAVE BEEN REDUCED BY PAID CLAIMS*THE INSURANCE AFFORDED BY THE POLICIES HEREIN IS SUBJECT TO ALL THE TERMS1 <br /> —• - - '— " '—r^ POLICYEFF '[YI.rLht POLICYEXP ' t' LIMITS <br /> -- • DOUSUBR POLICY NUMBER i lr, MfC+(sj�? ' L • " <br /> IN"Rl TYPE OF INSURANCE 1 >i�ji lyj) E _ 0,000,000 <br /> son; <br /> S <br /> 3 A X I COMMERCIAL GENERALUABiLITY DAMAGETO,FtENIEO + 6010OQ <br /> I - CLAIMS-MADE DX OCCUR 93-00.26-72-0007 110111!2021 10/1112022 �LskS_tke.�i ""'�;t a 60 0 <br /> X Pollution & Profess i MEDEXR ARJ &yens. teen s 10,000,000 <br /> I •_ I • -- PERSON,— AL & ADVINJURY ' _S�_—... 0,000,000 <br /> J ,-- • _ __. -- GENERAL AGGREGATE ,. „S • <br /> GEN'LAGGREGATE LIMIT AP IES PER: � I0,000�OO� <br /> pRpDUCTS GOMPlOPAGG : S --- 1 ,000,000 <br /> LOTHIR7 <br /> Y LOC j IMO D SEE REMARK ! s. - <br /> i _ � .» I1GHMtc4_vCClll`_ _S 11 00' 0 <br /> B l AUTOMOBILE LIABILITY I 4/1 /2021 , 411 /2022 I BODILY INJURY' Per rsan ' s <br /> IB <br /> AW (22) 58661065 - t - J <br /> i X ANY AUTO B�CCHEpp��LED ! BODILYINJURY. IPerBctl�nfj , S _ <br /> AURTObONLY ANpUrr��SwNp I eorM, Rde Il MAGE - — <br /> I AUTOS ONLY AUTOONIQ <br /> EACH OCCURRENCE•_ S _ <br /> I UMBRELLA UAB ( OCCUR AG RFI fp ITS � . _ .. . ....�_ _ -- <br /> EXCESSLIAejCWMSMADE ; <br /> i DED ' 7TRETENTIONf_ <br /> Cm WORKERS COMPENSATION _ 1 000,0OR <br /> AND EMPLOYERS' LIABILITY y I N '; 19073219-21 P 10/112021 ! 1011 /2022 1 EL EACH ACCIDENT - — 1 ,000,000. <br /> ANY PROPRIETORIPARTNERIEXECUTNE INIA • EL DIISEASE - FAEMPLOYEC 3 <br /> OFFICER/M�M� EXCIUDED7 11006,000 <br /> (Manch cry n 1 IE.L. DISEASE - POLICY UMR ; d: <br /> if es deacdbeunder - 0 ,00 <br /> DESdRIPTIONOFOPERATIONSbelow I — _._ — 4 021 4 022 ggregatelOCc. , <br /> D <br /> ( Excess AutoA only S '22J 588�1�fi6— - <br /> ES IACORD totSo <br /> , Additional Remarks heduis, may be attached H re moSpace Is to V a <br /> DESCRIPTION OF OPERATIONS ! LOCATIONS ) VEHICLj <br /> RE , Proof of Coverage <br /> I <br /> i <br /> I <br /> –��— CANCELLATION <br /> CERTIFICATE HOLDER — -- -- <br /> I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> DATE <br /> Able Maintenance, Inc, <br /> ATHE EXPIRAION <br /> CCORDANCE WITH THE POLICY P OV1S ONSCE WILL BE DELIVERED IN <br /> � — 3224-Re9r6rial •Parkway <br /> Santa Rosa , CA 96403 AUTHORIZED REPRESENTATIVE <br /> -- _-------- --`----- ` © 19$8-201'57aCaRD CORPORATION. All rights reserved. <br /> ACORD 25 ( 2016103 ) Arnaac&s.nf9CORD <br /> D4tame-anti-logo•are-registered-m ____ <br />