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DATE (MM/DD/YY) , <br />ACORD CERTIFICATE OF LIABILITY INSURANCE <br />09/09/05 <br />PRODUCER 1-503-222-1831 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />JBL&X Risk Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />220 NW 2nd Ave Suite 800 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />COMPANIES AFFORDING COVERAGE <br />Portland, OR 97209-3951 COMPANY <br />A Clarendon America Insurance Cc <br />INSURED <br />COMPANY <br />City of Eugene <br />B <br />COMPANY - <br />777 Pearl St Rm 101 <br />C <br />COMPANY <br />Eugene, OR 97401 <br />D <br />COVERAGES <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSUANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, <br />NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE <br />ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF <br />SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />CO <br />LTR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICY EFFECTIVE <br />POLICY EXPIRATION <br />LIMITS <br />DATE(MMIDDIYY) <br />DATE(MMIDD/YY) <br />GEN <br />ERAL LIABILITY <br />GENERAL AGGREGATE <br />$ <br />COMMERCIAL GENERAL LIABILITY <br />PRODUCTS - COMPIOP AGG <br />_ <br />$ <br />CLAIMS MADE D OCCUR <br />PERSONAL & ADV INJURY <br />$ <br />OWNER'S & CONTRACTOR'S PROT <br />EACH OCCURRENCE <br />$ <br />FIRE DAMAGE (Any one fire) <br />$ <br />MED EXP (Any one person) <br />$ <br />AUT <br />OMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />$ <br />ANY AUTO <br />ALL OWNED AUTOS <br />BODILY INJURY <br />SCHEDULED AUTOS <br />(Per person) <br />$ <br />HIRED AUTOS <br />BODILY INJURY <br />NON-OWNED AUTOS <br />(Per accident <br />$ <br />PROPERTY DAMAGE <br />$ <br />GARAGE LIABILITY <br />- <br />AUTO ONLY - EA ACCIDENT <br />$ <br />ANY AUTO <br />OTHER THAN AUTO ONLY: <br />EACH ACCIDENT <br />$ <br />AGGREGATE <br />$ <br />A <br />EXCESS LIABILITY <br />XSR00311127 <br />07/01/05 <br />07/01/06 <br />EACH OCCURRENCE <br />$ 5,000,000 <br />UMBRELLA FORM <br />AGGREGATE <br />$ 5,000,000 <br />X <br />OTHER THAN UMBRELLA FORM <br />Self-Ins Retentio <br />$ 500.000 <br />WORKERS COMPENSATION AND EMPLOYERS' <br />WC STATU- <br />OTH- <br />LIABILITY <br />TORY LIMITS <br />ER <br />EL EACH ACCIDENT <br />$ <br />THE PRIORIETOR/ <br />PARTNERSIEXECUTIVE <br />INCL <br />EL DISEASE - POLICY LIMIT <br />$ <br />OFFICERS ARE: <br />EXCL <br />EL DISEASE - DISEASE <br />$ <br />OTHER <br />DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESISPECIAL ITEMS <br />Re: Easement to Mt Hagen Communication Facility through Mt Hagen Fire Road <br />CERTIFICATE HOLDER <br />CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />Diustina Land & Timber CO LLP <br />EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS <br />WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO <br />MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE <br />1991 W 2nd <br />COMPANY ITS AGENTS OR REPRESENTATIVES. <br />Eugene, OR 97402 <br />AUTHORIZED REPRESENTATIVE <br />j i <br />& <br />USA <br />P <br /> <br />M►-'Y1 V' <br />ACORD 25-S (1/95) <br />ACORD CORPORATION 1988 <br />Busie.ttuxinger <br />3379955 Powered ByCertificatesNow'u <br />