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2008/AUG/07/THU 10:52 AM <br />WESTERN STATES INSUR FAX No, 5412 9860 <br />P. 001 <br />OP ID MF <br />&Of CERTIFIC TE OF LIABILITY INSURANCE <br />DATE (MMMD/VYYY) <br />CROCK-1 <br />08/07/08 <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 />NAIC0 <br />INSURED <br />INSURER A: Reetern Notional Assurance Com <br />T&M TOW1ngg <br />INSURERB: Western Natlonel Assurance Cam <br />DRA: Crockett r S Towing <br />Tim Bumgardner <br />INSURER C: Western National Aaaorance Com <br />29887 XelsO $t. <br />INSURER D: <br />Eugene OR 974.02 <br />INSURER E: <br />rnvccnr_Gc <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 />DATEMWDD~ E <br />PDATE MMI D <br />LIMITS <br />GENERAL LIABILITY <br />EACH000URRENCE <br />$1 000,000 <br />A <br />X <br />COMMERCIAL GENERALLIABIUTY <br />CP300009609 <br />01/31/08 <br />01/31/09 <br />PREMMIiSES(Eeoccufence) <br />$100,000 <br />CLAIMS MADE 7 OCCUR <br />MED EXP (Any one person) <br />$5,000 <br />PERSONALS ADV INJURY <br />$1,000,000 <br />GFNERALAGGREGATE <br />s2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER <br />PRODUCTS - COMP/OP AGG <br />$2,000,000 <br />POLICY jECT LOC <br />AUT <br />OMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />000 <br />000 <br />$1 <br />A <br />ANY AUTO <br />CA300513267 <br />01/31/08 <br />01/31/09 <br />(Eaaccidem) <br />r <br />' <br />ALL OWNED AUTOS <br />BODILY INJURY <br />$ <br />X <br />SCHEDULED AUTOS <br />(Per person) <br />X <br />HIRED AUTOS <br />BODILY INJURY <br />$ <br />X <br />NON-OWNED AUTOS <br />(Pere=ldenl) <br />PROPERTY DAMAGE <br />S <br />(Per accident) <br />GARAGE LIABILITY <br />AUTO ONLY-EA ACCIDENT <br />$1,000 L000 <br />A <br /> <br />ANY AUTO <br />CA300529733 <br />01/31/08 <br />01/31/09 <br />OTHERTHAN EA ACC <br />S 1 000,000 <br />X <br />OTHER THAN AUTO <br />AUTO ONLY., AGG <br />S 2 000 ODO <br />EXCESSIUMBRELLA LIABILITY <br />EACH OCCURRENCE <br />$ <br />CLAIMS MADE <br />OCCUR <br />AGGREGATE <br />$ <br />_ • <br />E <br />DEDUCTIBLE <br />$ <br />RETENTION S <br />$ <br />IDTH- <br />WORKERS COMPENSATION AND <br />TORY LIMITS ER <br />EMPLOYERS' LIABILITY <br />E.L. EACH ACCIDENT <br />S <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />E.L. DISEASE - EA EMPLOYE <br />S <br />IfyyoesIAL desrdibe under PROVISIONS below <br />SPEGL <br />E,L DISEASE -POLICY LIMIT <br />$ <br />OTHER <br />DESCRIPTION OF OPERATIONS I LOCATIONS I 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 />Leis i irn.m i C nvwc~ <br />--PROOF <br />- - - <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MALL 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 LIABLITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />Parks & Open Space Division <br />d <br />Bl <br />l <br />REPRESENT TIVES. <br />v <br />t <br />1820 Rooseve <br />Eugene OR 97402 <br />U REPR T IVE <br />m A r~or~ nAGbAC ATINU A GOO <br />ACORD 25 (2001106) <br />