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OP ID MF <br />ACORD CERTIFICATqOF LIABILITY INSURAN <br />DATE (MM/DDm'YY) <br />CROCK-1 <br />01/15/09 <br />PRODUCER <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Western States - Cottage Grove <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />339 Pacific Highway South <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Cottage Grove OR 97424 <br />Phone: 541-942-0555 Fax: 541-942-9860 <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURED <br />INSURER A: Western National Assurance Com <br />T&M Towingg <br />INSURER B: Western National Assurance Com <br />DBA: Crockett's Towing <br />Tim Bumgardner <br />INSURER C: Western National Assurance Com <br />29887 Kelso St. <br />R 97402 <br />INSURER D: <br />Eugene O <br />INSURER E: <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />LTR <br />NSR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICY EFFECTIVE <br />DATE MM/DD/YY <br />POLICY EXPIRATION <br />DATE MM/DD/YY <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />$1,000,000 <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CP300009609 <br />01/31/09 <br />01/31/10 <br />UAMAUt11J11I=N L) <br />PREMISES (Eaoccurence) <br />$100,000 <br />CLAIMS MADE 7 OCCUR <br />MED EXP (Any one person) <br />$5,000 <br />PERSONAL & ADV INJURY <br />$ 1, 000, 000. <br />GENERAL AGGREGATE <br />$'2 r000 , 000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG <br />s2,000,000 <br />POLICY PRO- <br />JECT LOC <br />AUT <br />OMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />$1 <br />000 <br />000 <br />A <br />ANY AUTO <br />CA300513267 <br />01/31/09 <br />01/31/10 <br />(Ea accident) <br />, <br />, <br />ALL OWNED AUTOS <br />BODILY INJURY <br />$ <br />X <br />SCHEDULED AUTOS <br />(Per person) <br />X <br />HIRED AUTOS <br />BODILY INJURY <br />$ <br />X <br />NON-OWNED AUTOS <br />(Per accident) <br />PROPERTY DAMAGE <br />$ <br />(Per accident) <br />GARAGE LIABILITY <br />AUTO ONLY - EA ACCIDENT <br />$1,000,000 <br />A <br />X <br />ANY AUTO <br />CA300529733 <br />01/31/09 <br />01/31/10 <br />OTHER THAN EA ACC <br />$1,000,000 <br />X <br />OTHER THAN AUTO <br />AUTO ONLY: AGG <br />s2,000,000 <br />EXCESS/UMBRELLA LIABILITY <br />EACH OCCURRENCE <br />$ <br />OCCUR F7 CLAIMS MADE <br />AGGREGATE <br />$ <br />DEDUCTIBLE <br />$ <br />RETENTION $ <br />$ <br />WORKERS COMPENSATION AND <br />TORY LIMITS ER <br />EMPLOYERS' LIABILITY <br />E.L. EACH ACCIDENT <br />$ <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />If yes, describe under <br />SPECIAL PROVISIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />OTHER <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br />Truckers - Towing Operations (See attached Schedule of Various On-Hook <br />Coverages Limits per Specific Vehicle <br />CFRTIFICOTF Hnl_DFR CANCELLATION <br />--PROOF <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN <br />City of Eugene <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />Public Works Maintenance and <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />Parks & Open Space Division <br />1820 Roosevelt Blvd <br />REPRESENT TIVES. <br />Eugene OR 97402 I <br />mm E T 'VW <br />ACORD 25 (2001/08) U AGuku COKPORA iuN ivaa <br />