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SERVSTA-CL DWATTS
<br /> r CERTIFICATE F LIABILITY INSURANCE ~ °ATE'MM'°°"YYY'
<br /> 11/19/2024
<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 INSUIRER(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 such endorsement(s).
<br /> R License# 0603247 CONTACT
<br /> PRODUCER I„NAME:
<br /> -_-- __.
<br /> George Petersen insurance Agency, Inc. PHONE FAX,No):(707) 525-4175
<br /> �P.O. Box 3539 � IAIc,No,Extg (707) 525-4150
<br /> Santa Rosa, CA 95402 ;AD�RIE$S:info@gpins.com
<br /> INSURER(E4AFFORDING COVERAGE —_ _ NAIC ii___
<br /> INSURER A:Westchester Surplus Lines Insurance Co. 10172
<br /> INSURED INSURER B_Ace American Insurance Co 122667
<br /> Service Station Systems, Inc. INSURER C_Insurance Company of the West 27847
<br /> 3224 Regional Parkway INSURER D Colonv Insurance Com an !39993
<br /> Santa Rosa, CA 95403 - - Y_ __-- -- --_--__.
<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 /> - - - — — —
<br /> INSR I TYPE OF INSURANCE
<br /> :ADDLiSUBR, POLICY EFF -POLICY EXP — ----- - --- - - --- ----
<br /> � POLICY NUMBER LIMITS
<br /> INSURANCE__��.J�GSO.1vYvo JMMro tMM_7D41YY`O'�m _
<br /> A I X COMMERCIAL GENERALLIABILnY ( i EACH OCCURRENCE $ 1,000,000
<br /> I DAM
<br /> CLAIMS-MADE ® OCCUR ;G4750045A 001 11/15/2024 11M512025 I pp AGE TO RENTEDMI>E rE o 4t Bri�A . c 100,000
<br /> X Environmental Liab 5 000
<br /> i_MED EXP iAny one Person) : $ ___.. _--,___ .
<br /> PERSON &ADYINJURY Y 1,000,000
<br /> L A
<br /> 'L AGGREGATE LIMIT APPLIES PER: �_G_ENERAL AGGREGATE 2,000,000
<br /> GEN _-_
<br /> j POLICY a PRO-
<br /> PRODUCTS LOC ! x 2,000,000
<br /> JECT PRODUCTS-COMP/OP AGG _
<br /> __-
<br /> OTHER: _ _ — iPROFESSIONAL AN 1,000,000
<br /> i �
<br /> B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1 1,000,000
<br /> gE accident?._.. I $
<br /> -X ANY AUTO H08887147 001 11/15/2024 11/15/2025 + BODILY INJURY{Par ner-so-n lOWNED SCHEDULED
<br /> _I
<br /> AUTOS ONLY _ _ _ AUTOS
<br /> I BODILY INJURY(Per accident)l $ 777
<br /> -..._.__ - { - PROPERTY DAMAGE -l HIRED AUTOSNON-OWNEDLY €
<br /> AUTOS ONLY AUTOS ONLY i 1 Per aceWahl I E a
<br /> i I i 1
<br /> A UMBRELLA LIAB X OCCUR >, EACH OCCURRENCE _ $ 5,000.000
<br /> X EXCESS LIAB CLAIMS MADE; G47500461 001 11/15/2024( 11/15/2025 ; AGGREGATE 5,000,000
<br /> I DED I RETENTION$ _ . ,,.,.__......
<br /> C j WORKERS COMPENSATION X PER OTH-
<br /> AND EMPLOYERS'LIABILITY STAI L i v_ --_ ER
<br /> p YIN i
<br /> WPL 5078218 00 6/412024 6/4/2025 1,000 000
<br /> (Mandatory In NH) N f A E.L. EACH ACCIDENT a _
<br /> Ifyes,dens In H) XC UDED?ECUTNE E,L.DISEASE-EA EMPLOYEE 11000'000
<br /> --
<br /> IDESCRIPTIONOF OPERATIONS belovr E.L. DISEASE-POLICY LIMIT S 1,000,000
<br /> D !Excess Liab 2nd laye EX04281637 11115/2024 11/15/2025 IOCC &AGG f 4,000,000
<br /> i
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more apace Is required) _
<br /> RE: Proof of Coverage
<br /> CERTIFICATE_HOLDER_ .,, CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 13E CANCELLED BEFORE
<br /> I 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 (2016103) © 1988-2015 ACORD CORPORATION. All rights reserved.
<br /> The ACORD name and logo are registered marks of ACORD
<br />
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