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JUN-15 THU 12:32 PACIFIC BENEFITS CNSLTNS FAX NO. 503 484 4271 P,02 <br /> INSURANCE BINDER NO. 1 <br /> THIS BINDER IS A TF,IVIPORARY CONTRACT OF <br /> INSURANCE AND IS SUBJECT TO ALL CONDMONS <br /> STIPULATED HEREIN. <br /> Pending policy issuance, the undersigned hereby binds coverage as set forth, on behalf of the following <br /> insurer: RAINIER INSURANCE COMPANY <br /> NAMED INSURED: Mary Kelley <br /> MARLING ADDRESS: 3865 Royal Ave.; Eugene, OR 97402 <br /> COVERAGE: Basic Form Property and Commercial General Liability EXCLUDING. MEDICAL <br /> PAYMENTS. Property Coverage will be excluded at the time the home is in transit from the current <br /> location to the fixture location. <br /> LIMITS: Property - S117,000 Building and Liability - 55 (Policy Prod: 6/15/95 to <br /> 12/15/95) <br /> DEDUCTIBLE: Property - $250. and Liability - $250. BI/PD Per Claim Including Loss. Adjustment <br /> BINDER PERIOD: Effective 12 :01 AM. 6 -15.95 and expires exactly thirty (30) days the at 12;01 <br /> A.M. 7 -15 -95 standard time at the address of the Named Insured. <br /> RETROACTIVE DATE: Not Applicable . <br /> POLICY NUMBER ASSIGNED: SCP7I01 30-0 1 <br /> PREMIUM: 5500. + $100. Fee + $3.00 Fire Marshall + 513.50 State Tax + $1.00 SLSC <br /> Grand Total = S617.50 <br /> The coverage provided by this binder is subject to all provisions of the policy in contemporary use as well <br /> as all teams specified in the quotation rendered by INDEMNITY EXCESS & SURPLUS AGENCY, INC. <br /> and dated 4- 18 -95. <br /> It is expressly provided that this binder will automatically terminate upon issuance of the policy. <br /> BY: Kfhnz4■ " e- 4,44;44 -- <br /> • <br /> INDEMNITY EXCESS & SURPLUS AGENCY, INC. OREGON SURPLUS LINES LICENSEE *805168 <br /> on behalf of the insurer <br /> 6 -15 -95 <br /> oat "THIS IS EVIDENCE Of INSURANCE PROCURED AND DEVELOPED <br /> UNDER THE OREGON SURPLUS LINE LAWS. IT IS NOT COVERED BY <br /> THE PROVISIONS OF ORS 734410 TO 734.710 RELATING TO THE <br /> OREGON INSURANCE GUARANTY ASSOCIATION. IF THE INSURER <br /> ISSUING THIS INSURANCE BECOWUES INSOLVENT, THE OREGON <br /> INSURANCE GUARANTY ASSOCIATION HAS NO GRLIGATION TO <br /> PAY CLAIMS UNDER THIS EVIDENCE OF INSURAAICE,- <br /> • <br />