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Commercial Certificate Insurance <br /> FARMER s <br />Agency Santanalnsurance Agency <br />Name .5605 Inland Shores Wy #102 Issue Date (MM/DD/YY) OS/OS/10 <br />& Keizer, OR 97303 <br />Address 503-393-6771 This certificate is issued as a matter ofinformation only and confers no rights <br /> upon [he certiFlcate holder. This certificate does not amend, extend or alter the <br />St. 73 Dist. 10 Agent 315 <br />coverage afforded by the policies shown below. <br /> Companies Providing Coverage: <br />Insured Company Q Tivek Insurance lixchanpc <br />. Stapleton Timber & Excavation Lauer <br />Name PO Rox 40505 company B Farmmslnsurance Exchange <br />& Eugene, OR 97404 Letter <br />~ny CMid-Century Insurance Company <br />i ~ <br />Address t~r <br /> Company <br /> IsLLer <br />Coverages <br />This is to certify [hat the policies of insurance listed below have bee n issued to [he insured named above for the policy period indicated. Notwithstanding <br />-any requirement,-termor condition of any contractor other docum cnrwith-resperi to which this certificate may t>c iuuedor may pertain, the insurance <br />afforded by the policies described herein is subject to all the terms, exclusions and conditions of such policies. Limits shown may have been reduced by <br />paid claims. <br />Co. <br />L[r. T e of Insurance <br />yP Polic Number <br />y Policy Effective <br />Date (MM/DD/YYI Policy Expiration <br />Dale (MM/DD/YY) polic Limits <br />Y <br /> General Liability General Aggregate g <br /> Commercial General Products-Comp/OPS <br /> Liability ~ ~ Aggregate $ <br /> Personal & <br /> -Occurrence. Version Advertising Injury $ <br /> Contractual- Incidental Each Occurrence $ <br /> Only - ~ .. Fire Damage <br /> (Any one Ore) $ <br /> Owners & Contractors Prot. Medical Expense <br /> (Any one person) $ <br />C X Automobile Liability 60473-72-32 OS/Og/]0 OS/II/ll CombinedSinglc <br />Limit <br /> All Owned Commercial $ 1,000,000 <br /> Autos Bodily Injury <br />~ <br /> X Scheduled Autos I (Perperson $ 1,000,000 <br /> X Hired Autos Bodily Injury <br />(Per accident) <br />$ 1,000,000 <br /> X Non-Owned Autos <br /> Gamge Liability Property Damage $ 1,000,000 <br /> Garage Aggregate $ <br /> Umbrella Liability Limfr g <br /> Workers' Compensation Statutory <br /> and Each Accident $ <br /> <br />Employers' Liability DiaCBSC -Each Employee <br />Disease - Policy Limit $ <br />$ <br />Description of Opera[ions/Vehicles/Restrictions/Special items: <br />Certificate Holder is Named Additional Insured. ~ __ `~I ~~~~ <br />Certificate Holder i Cancellation <br />City, of Eugene Should any of the above described policies be cancelled before the expiration date <br />Name Public Works Dept thereof, the issuing company will endeavor ro mail 30 days written notice to the <br />& _ •'~ 1820 Roosevelt Blvd ~ certificate holder named to [he left, but failure.[o mail such notice shall impose no <br />Address ~ ~ -Eugene, OR 97402 obligation or liability of any kind upon the company, i[sagents or representatives. <br /> Authorized Representative ' <br />5n-Z4'r2 ^-v< Copy Distribution: Service Center Copy and Agent's Copy H.nr <br />