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-., SERVSTA -CL DWATTS <br /> A Ro CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDrr ) <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 have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy , certain policies may require an endorsement. A statement on <br /> this certificate does not confer rights to the certificate holder in lieu of suchppendorsement(s) . <br /> PRODUCER License # 0603247 NAMEACT <br /> George Petersen Insurance Agency, Inc. �A/c°°,No, Ext): (707) 525-4150 FA/c, No): (707) 525-4175 <br /> P.O . Box 3539 MAIL <br /> Santa Rosa, CA 95402 AE-DDRE : info@gpins .com <br /> INSURERS AFFORDING COVERAGE NAIC # <br /> INSURERA : Ore on Mutual Insurance Company 14907 <br /> INSURED INSURERB : WCF Select Insurance Company <br /> Service Station Systems, Inc. INSURER C : <br /> 3224 Regional Parkway INSURER D : <br /> Santa Rosa , CA 95403 <br /> INSURER E <br /> INSURER F : <br /> COVERAGES CERTIFICATE NUMBER : REVISION NUMBER : <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 BEEN REDUCED BY PAID CLAIMS. <br /> INSRTypE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br /> LTR VD M /DD DD <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ <br /> CLAIMS-MADE [ ] OCCUR DAMAGES ( RENTED <br /> PREMISES Ea occurrenc@L. $ <br /> MED EXP (Any oneperson) <br /> PERSONAL & ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ <br /> POLICY ❑ JECT LOC PRODUCTS - COMP/OP AGG $ <br /> OTHER: $ <br /> A COMBINED SINGLE LIMIT 11000,000 <br /> AUTOMOBILE LIABILITY Ea accident $ <br /> X ANY AUTO CM02924704 11 /15/2022 11 /15/2023 BODILY INJURY Perperson) $ <br /> OWNED SCHEDULED <br /> AUTOS ONLY AUTOS Ep BODILY INJURY Per accident $ <br /> AUT OS ONLY AUT16 V81a PPeoacatlent AMAGE $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION $ <br /> B WORKERS COMPENSATION X PER UTE E5TH- <br /> AND EMPLOYERS' LIABILITY YIN <br /> N E. L. EACH ACCIDENT $4046603 6/4/2023 6/4/2024 1 ,000, 000 <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE N / A <br /> OFFICER/MEMBER EXCLUDED? <br /> (Mandatory In NH) E. L. DISEASE - EA EMPLOYEE $ 1 '000 '000 <br /> If yes, describe under 1 , 0001000 <br /> DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101 , Additional Remarks Schedule, may be attached If more space is required) <br /> RE: Proof of Coverage <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Service Station Systems, Inc. ACCORDANCE WITH THE POLICY PROVISIONS. <br /> 3224 Regional Parkway <br /> Santa Rosa, CA 95403 <br /> AUTHORIZED REPRESENTATIVE <br /> ACORD 25 (2016/03) @ 1988 -2015 ACORD CORPORATION . All rights reserved . <br /> The ACORD name and logo are registered marks of ACORD <br />