Laserfiche WebLink
Client#: 1047352 SERVISTA10 <br /> CERTIFICATE I ILIT I m DATE(MWDDNYYY) <br /> 6/09/2025 <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 /> IM RTANT: IF the certlflDate holder is an ADDITIONAL INSURED, the po icy les) must have D TIO A INSURED provisions Dr be endoreed. <br /> If SUBROGATION IS WAIVED, sub)ect to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br /> this aertiflcate does not confer any Hghts to the certificate holder In lieu of such endorsement(s), <br /> PRODUCER <br /> USI Insurance Services NW CL1 AME: Rhonda Scialpi <br /> P�rc o ; 503 224.8390 Nel, ti10 362-8130 <br /> $25 NE Multnomah, Suite 1500 AooREss: rhondascialpi@usi.com _�S <br /> Portland, OR 97232 <br /> 503 224.8390 INSURER(S)AFFORDING COVERAsE NAIL# <br /> INSURERA: Insurance Company of the West 27847 <br /> INSURED .""_"'_ --- <br /> Service Station Systems, Inc. INSURER B <br /> 3224 Regional Parkway INSURER C: <br /> Santa Rosa, CA 95403 INSURERD: <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 INSU%PER90NAL <br /> D ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHERT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE IN5URANCE AFFORDED BY THE PDLICIES IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCE LT R �� TYPE OF INSURANCE -� `` " �LTR LIMITS <br /> COMMERCIAL GENERAL LIABILICCURRENCEI CLAIMS•MAOE OCCURS(EoacE-'� ES 1P(An one perNAL&ADVINJURY $ <br /> GEN L AGGREGATE LIMIT APPLIES PER. <br /> PRO- GENERAL AGGREGATE $ _ <br /> I <br /> POLICY ❑ JECT LOC PRODUCTS•COMP/OP AGG $ <br /> OTHER: $ <br /> AUTOMOBILE LU1814nY { <br /> _ O ASIC)$1N 'LTt�I <br /> Ea scd nt _ <br /> f ANY AUTO OWNED SCHEDULED BODILY INJURY(Par person) $ <br /> f <br /> AUTOS ONLY AUTOS BODILY INJURY(Per accident) S <br /> UTOS <br /> AUTOS ONLY AUTOSNON-OWNED ONLY <br /> ROP RTY AB <br /> A Per accldenl $ <br /> UMBRELLA LIAB -•..--..._.__. .�, _.__ <br /> OCCUR — � EACH OCCURRENCE $ <br /> I EXCESS LIAB -- <br /> GLAIMS•MAOE : AGGREGATE $ <br /> DED RETENTION$ <br /> __ <br /> WORKERBCOMPENSATION -- __— <br /> '� AND EMPLOYERS'LIABILITY WLV507821$01 6/04/2025 06l04l202 X PER <br /> —_ <br /> ANY PROPRIETOWPARTNER/EXECUTIVE YIN <br /> SSA7JJIE_ <br /> OFFICER/MEMBER EXCLUDED? � N/A <br /> El.EACH ACCIDENT $1 000000 <br /> Ilyea,describe under Mandatory In N <br /> t ( E.L.DISEASE-EA EMPLOYEE $1 000 000 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT E1,000 000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 11011,Addhlonai Remarks Schedule,maybe attached IT more apace Is required) <br /> A waiver of subrogation applies where required by written contact . <br /> CERTIFICATE HOLDER CANCELLATION <br /> Service Station Systems, Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> 3224 Regional Parkway ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Santa Rosa, CA 95403 <br /> AUTHORIZED REPRESENTATIVE <br /> t P . <br /> © 1998,2015 ACORD CORPORATION.All rights reserved, <br /> ACORD 25 (2016103) 1 of 1 The ACORD name and logo are registered marks of ACORD <br /> NS49677197IM49574723 BLKZP <br />