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Client#: 2079581 ABLEMAH <br /> ACOrn, <br /> CERTIFICATE F LIABILITY I DATE(MM/DD/YYYY) <br /> 10/01/2025 <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 /> IMPORTANT; If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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 any rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER <br /> NAME Rhonda Sclalpi _ <br /> USI Insurance Services NW CL1 PHONE 503 224 8390 FAx 610 362 8130 <br /> ISA/C No,EMJ:_. . yVC,No) <br /> 825 E Multnomah, Suite 1500 E-MAIL rhonda.scial I usi.com <br /> ;ADDRESS: p�i� <br /> Portland, OR 97232 _ — <br /> 503 224.8390 INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURER A: Zurich American Insurance Company 116535 <br /> INSURED INSURER B <br /> Able Maintenance, Inc. INSURER C - — - - -- <br /> 3224 Regional Parkway _ -_ _—_ -------------- <br /> INSURER D <br /> Santa Rosa, CA 95403 - --- -- -- --- <br /> fINSURER 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 CONTRACTOR 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 /> INSR _ - ADDLSUBR — — — POLICYEFF POIICYEXP <br /> LTR TYPE OF INSURANCE <br /> _ IINSR IWVD_ POLICY NUMBER (MMIDDIYYYY MM/DD/YYYY) LIMITS <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ <br /> f CLAIMS-MADE OCCUR i DAMAGE TO RENTEU <br /> PREMISES(Es occurrence) $ <br /> I <br /> jI MED EXP(Any one person) $— <br /> ..__._. ------- -L. ..-.i <br /> 1 I PERSONAL&ACV INJURY $ <br /> GEN'LAGGREGATE LIMITAPPLIES PER: <br /> POLICY JECT <br /> ❑ PR0. ❑ ] GENERALAGGREGATE $ _ <br /> i LOC { PRODUCTS-COMP/OPAGG is <br /> OTHER: ] $ <br /> AUTOMOBILE LIABILITY ? COMBINED SINGLE LIMIT - -- - - - <br /> __._. iEaacddent) c <br /> ANY AUTO ' BODILY INJURY(Per person) $ <br /> — OWNED i SCHEDULED BODILY INJURY Per accident $ <br /> AUTOS ONLY j AUTOS ( ) <br /> HIRED NON-OWNED -PROPERTY DAMAGE - - <br /> --- <br /> AUTOS ONLY AUTOS ONLY (Per accident) _ $ <br /> -. <br /> j UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> -- I _._.---CCUR <br /> EXCESS LIAB CLAIMS-MADEI ! AGGREGATE $ <br /> DED RETENTION$ I $ <br /> A WORKERS COMPENSATION ? 8897913 10/01/202510i01/2026X�PER BOTH-i <br /> AND EMPLOYERS'LIABILnY YIN SIAIULE <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E L.EACH ACCIDENT $1 OOO OOO <br /> OFFICER/MEMBER EXCLUDED? ® N I A _..._ -.__ _ a. .._r <br /> (Mandatory In NH)If yes,describe under ' EL.DISEASE-EA EMPLOYEE $1,000,000 <br /> ------- -- <br /> DESCRIPTION OF OPERATIONS below E.L. DISEASE-POLICY LIMIT $1,000,000 <br /> j <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) <br /> RE: Removing Gas pumps & Tanks <br /> 1409 Grove St. LLC, Managing Members of the LLC: Marc Opperman, Scott Silveria and Joe Belli are named as <br /> Additional Insured with respects to General Liability per attached. <br /> CERTIFICATE HOLDER CANCELLATION <br /> 1409 Grove St. LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> 280 Kinley Dr. ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Healdsburg, CA 95448 <br /> AUTHORIZED REPRESENTATIVE <br /> © 1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25 (2016103) 1 of 1 The ACORD name and logo are registered marks of ACORD <br /> #S51099954/M51070548 PDNZP <br />