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<br />CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MM/DD/YYYY) <br />11/20/2013 <br />THISCERTIFICATEISISSUEDASAMATTEROFINFORMATIONONLYANDCONFERSNORIGHTSUPONTHECERTIFICATEHOLDER.THIS <br />CERTIFICATEDOESNOTAFFIRMATIVELYORNEGATIVELYAMEND,EXTENDORALTERTHECOVERAGEAFFORDEDBYTHEPOLICIES <br />BELOW.THISCERTIFICATEOFINSURANCEDOESNOTCONSTITUTEACONTRACTBETWEENTHEISSUINGINSURER(S),AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT:IfthecertificateholderisanADDITIONALINSURED,thepolicy(ies)mustbeendorsed.IfSUBROGATIONISWAIVED,subjecttothe <br />termsandconditionsofthepolicy,certainpoliciesmayrequireanendorsement.Astatementonthiscertificatedoesnotconferrightstothe <br />certificate holder in lieu of such endorsement(s). <br />CONTACT <br />PRODUCER <br />MitchHanan <br />JodieHanan <br />NAME: <br />FAX <br />PHONE <br />541-747-4266541-747-9772 <br />111S.47thSt <br />(A/C, No): <br />(A/C, No, Ext): <br />E-MAIL <br />jodie.hanan.hpkf@statefarm.com <br />ADDRESS: <br />Springfield,OR97478 <br />INSURER(S) AFFORDING COVERAGENAIC # <br />StateFarmFireandCasualtyCompany <br />INSURER A : <br />25143 <br />INSURED <br />FOURSEASONSTREESLLC <br />INSURER B : <br />POBOX234 <br />INSURER C : <br />INSURER D : <br />WALTERVILLEOR97489-0234 <br />INSURER E : <br />INSURER F : <br />COVERAGESCERTIFICATE NUMBER:REVISION NUMBER: <br />THISISTOCERTIFYTHATTHEPOLICIESOFINSURANCELISTEDBELOWHAVEBEENISSUEDTOTHEINSUREDNAMEDABOVEFORTHEPOLICYPERIOD <br />INDICATED.NOTWITHSTANDINGANYREQUIREMENT,TERMORCONDITIONOFANYCONTRACTOROTHERDOCUMENTWITHRESPECTTOWHICHTHIS <br />CERTIFICATEMAYBEISSUEDORMAYPERTAIN,THEINSURANCEAFFORDEDBYTHEPOLICIESDESCRIBEDHEREINISSUBJECTTOALLTHETERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />ADDLSUBR <br />INSRPOLICY EFFPOLICY EXP <br />TYPE OF INSURANCELIMITS <br />POLICY NUMBER <br />(MM/DD/YYYY)(MM/DD/YYYY) <br />LTR <br />INSRWVD <br />GENERAL LIABILITY <br />EACH OCCURRENCE$ <br />DAMAGE TO RENTED <br />COMMERCIAL GENERAL LIABILITY$ <br />PREMISES (Ea occurrence) <br />CLAIMS-MADEOCCURMED EXP (Any one person)$ <br />PERSONAL & ADV INJURY$ <br />GENERAL AGGREGATE$ <br />GEN'L AGGREGATE LIMIT APPLIES PER:PRODUCTS - COMP/OP AGG$ <br />PRO- <br />$ <br />POLICYLOC <br />JECT <br />COMBINED SINGLE LIMIT <br />AUTOMOBILE LIABILITY <br />$ <br />(Ea accident) <br />BODILY INJURY (Per person) <br />1,000,000 <br />ANY AUTO 1425035-E02-37 <br />$ <br />11/02/201305/02/2013 <br />ALL OWNEDSCHEDULED <br />BODILY INJURY (Per accident) <br />1,000,000 <br />$ <br />AUTOSAUTOS <br />1528956-F28-37 <br />06/28/201312/28/2013 <br />NON-OWNEDPROPERTY DAMAGE <br />1,000,000 <br />$ <br />HIRED AUTOS <br />(Per accident) <br />AUTOS <br />$ <br />UMBRELLA LIAB <br />EACH OCCURRENCE$ <br />OCCUR <br />EXCESS LIAB <br />CLAIMS-MADEAGGREGATE$ <br />$ <br />DEDRETENTION$ <br />WC STATU-OTH- <br />WORKERS COMPENSATION <br />TORY LIMITSER <br />AND EMPLOYERS' LIABILITY <br />Y / N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />E.L. EACH ACCIDENT$ <br />N / A <br />OFFICE/MEMBER EXCLUDED? <br />E.L. DISEASE - EA EMPLOYEE$ <br />(Mandatory in NH) <br />If yes, describe under <br />E.L. DISEASE - POLICY LIMIT$ <br />DESCRIPTION OF OPERATIONS below <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />CERTIFICATE HOLDERCANCELLATION <br />SHOULDANYOFTHEABOVEDESCRIBEDPOLICIESBECANCELLEDBEFORE <br />CityofEugenePublicWorks <br />THEEXPIRATIONDATETHEREOF,NOTICEWILLBEDELIVEREDIN <br />1820RooseveltBlvd. <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Eugene,OR97402 <br />AUTHORIZED REPRESENTATIVE <br />© 1988-2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05)The ACORD name and logo are registered marks of ACORD <br />1001486 132849.8 01-23-2013 <br />