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Client#, 1047352 LIABILITY <br /> SERVISTA10 <br /> ACORDT, CERTIFICATE OF ® ' I T INSURANCE DATE(MMIDDIYYI'YI <br /> 6/09/2025 <br /> T 9 <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 GY 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 /> I PO TA : if the aeRificate older Is sn OVAL INSURE , the po lcy(ies}must have A QITIONA INSURED provisions or be en orsed, <br /> If SUBROGATION IS WAIVED, sub)ect to the tatTns and cvnditlons of the policy, certain policies may require an endorsement A Statement on <br /> this certificate does not confer any rights to the certificate holder In Ileu of such endorsement(s), <br /> PRonucER <br /> USI insurance Services NW CL1 N E: Rhonda SCialpl <br /> �Awc No, Extl: 503 224.8390 ,etc Nd 610 362-8130 <br /> 825 NE Multnomah, Suite tS00 �:.e��--- �i s� <br /> AODREss: rhondascialpi@usl.com <br /> Portland, OR 97232 �_ <br /> 503 224.8390 INSURERS)AFFORDING COVERAGE NAIC N <br /> INSURER A: Insurance Company of the West 27647 <br /> _ - _ ��... <br /> INSURED INSURER B <br /> Service Station Systems, Inc. __ <br /> 3224 Regional Parkway INSURERc: <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 INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED, NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CERTIFICATE MAY BE CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCW POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> LTR TYPE OF INSURANCE INS WVp_� . __..". POLICY NUMBER .. (MM MM�pDrrrY LIMITS- _ v _„. <br /> COMMERCIAL 4ENERAL LIABILITY - -- <br /> EACH OCCURRENCE_ S <br /> CLAIMS-MADE OCCUR py�.,I,q. c, ate. E <br /> OE <br /> PPM�REEEDfifi99EXP(Army one person) $ _.. <br /> PERSONAL h ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: -- <br /> PRO- <br /> GENERALAGGREGATE $ <br /> POLICY JECT LOC PRODUCTS-COMP/OP AGG , S <br /> OTHER: _,' $ . <br /> AUTOMOBILE LIABILrTY 1 7— <br /> r�A�7Fl n�IN E LTm-I' <br /> I Ee ecctdent _ <br /> ANY AUTO BODILY INJURY Per^ <br /> OWNED SCHEDULED I ( pamon S <br /> AUTOS ONLY AUTOS BODILY INJURY(Per eccldent) $ <br /> HIRED <br /> ONLY NON-OWNED PR — <br /> ALTOS ONLY I Per eCCitlent A $ <br /> S <br /> � UMBRELLA LIAB =00rUR, <br /> EACH OCCURRENCE $ <br /> EXCESS LIAB ( <br /> AGGREGATE $ <br /> DED RETENTION 5 <br /> _ _ _ S A WORXERBCOMPENSATIDN WLV507821801 610412025 06/0412026 X PER- OTH. — <br /> AND EMPLOYERS'LIABILITY <br /> ANY PROPRIETDRIpARTNER/EXECLITIVE YIN STA L <br /> OFFICER/MEMSER E7fCLUDED7 ® NIA I E.L.EACH ACCIDENT $1 OOO OOO <br /> If es,deory I e NH) EL.DISEASE-EA EMPLOYEE$1 OOO OOO <br /> DESCRIPTION BI under OPERATIONS below — <br /> _ EL.DISEASE-POLICY LIMIT -1,000 000 <br /> i <br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 1 D1,Additional Remarks Schedule,may be attached If more space Is requlrod) <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 /> (D 1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25 (2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD <br /> #S49577197/M49574723 BLKZP <br />