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SERVSTA-CL DWATTS
<br />ARO CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/DDmrY)
<br />6/4/2025
<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(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 />PRODUCER License # 0603247 'CONTACT
<br />George
<br />P.O. Box 3539en Insurance Agency, Inc. I PHONE
<br />�( Ext): (7�gp 25-4150 (A/ , Noh(707) 525-4175
<br />-MAIL
<br />E-MAIL
<br />Santa Rosa, CA 95402 Info ms.com
<br />INSURERS AFFORDING COVERAGE NAIC #
<br />_ INSURER A: Westchester Surplus Li neS Insurance Co. 10172
<br />_
<br />INSURED
<br />Ace _226_67
<br />INSURER 13: American Insurance Co _
<br />Service Station Systems, Inc INSURER C : Colony InsUran_ce Company 39993
<br />_ _
<br />680 Quinn Avenue INSURER D:
<br />San Jose, CA 95112 - —
<br />INSURER E.
<br />INSURER F:
<br />COVERAGES CFRTIFICOTF NIIMRFR• nr111101^u ■u ■.er.,-
<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 />- -_1A-
<br />INSR DDL SUBR''. POLICY EFF POLICY EXP
<br />T TYPE OF INSURANCEp POLICY NUMBER D MM/D LIMITS
<br />A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br />CLAIMS -MADE X 1 OCCUR DAMAGE TO RENTED 100,000
<br />X Contractors Poll Lia 11/15/2025 -PREMISES (Ea $ -_
<br />4760045A 001 11/15/2024 MED EXP (E 5,000
<br />X $1,000,000 -- oneperson _$
<br />_PERSONAL & ADV INJURY $ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER: i GENERAL AGGREGATE 2,000,000
<br />POLICY X PE&- — LOC PRODUCTS - COMP/OP AGG $ 2,000,000
<br />OTHER: PROF Liab $ 1,000,000
<br />B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
<br />X ANY AUTO X X H08887147001 11/15/2024' BODILlINJU $ 1,000,000
<br />11/15/2025 BODILY INJURY Per erso� $
<br />OWNED .SCHEDULED -- --
<br />�. AUTOS BODILY INJURY (Per accident _$
<br />H RTOpS ONLY NON -OWNED PROPERTY DAMAGE
<br />AUTOS ONLY I'! AUTOS ONLY', �TPer acadent� $
<br />$
<br />A UMBRELLA LIAB X_: OCCUR EACH OCCURRENCE $ 5,000,000
<br />X ESS LIA5,000,000
<br />CLAIMS -MADE 647500461 001 11/15/2024 11/15/2025 AGGREGATE
<br />DEDRETENTION $
<br />WORKERS COMPENSATION PER 0TH
<br />AND EMPLOYERS' LIABILITY YIN N STATUTE ER
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE - E.L. EACH ACCIDENT _R $
<br />OFFICER/MEMBERnchaiEXCLUDED? N / A _ E.L. DISEASE - EA EMPLOYEE: $
<br />Mandato
<br />If es, describe under -- - -- - -
<br />DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
<br />C ''Excess Liab 2nd Jaye EX04281637 11/15/2024 11/15/2025 OCC & AGG 4,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />RE: #119075 - COP, ICE On -Call Services
<br />City of Pleasanton, its officers, employees and agents are named as Additional Insured with respects to General & Contractors Pollution Liability Ongoing &
<br />Completed Operations per ENV -3250 (12-18) & ENV -3251 (12-18). Primary wording per ENV -3232 (12-18). Waiver of subrogation per ENV -3143 (03-05). Auto
<br />Liability Additional Insured per DA6Z04a0614. Auto Primary wording per CA 04 49 11 16. Waiver of subrogation per DA13115a0614. , attached
<br />City of Pleasanton
<br />Attn: City Manager
<br />PO Box 520
<br />Pleasanton, CA 94566
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<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
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