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ACORD CERTIFICAT F LIABILITY INSURANC OP ID JW <br />DATE(MM/DD/YYYY) <br />GGROOIC <br />10/28/09 <br />PRODUCER <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />KPD Insurance, Inc. <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />Box 784 <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />ringfield OR 97477 <br />Ihone:541-741-0550 Fax : 541-741-1674 <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />RED <br />INSURER A: National Surety Corporation <br />INSURER B: <br />G Group LLC <br />INSURER C: <br />PO BOX 529 <br />Eugene OR 97440-0529 <br />INSURER D: <br />INSURER E: <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 />IN5R <br />LTR <br />ADD <br />NSR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICY EFFECTIVE <br />DATE MM/DD/YY <br />POLICY EXPIRATION <br />"DATE <br />MM/DD/YY <br />IMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1 000,000 <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />- <br />-MXX80912191 <br />11/01/09 <br />11/01, 1.0 <br />PRDAMAUt: TO RENT <br />EMISES Eaoccurence <br />$1,000,0M <br />CLAIMS MADE I <br />XI OCCUR <br />MED EXP (Any one person) <br />$ 20 000 <br />X <br />Contractual <br />PERSONAL BADVINJURY <br />$1 000000 <br />GENERAL AGGREGATE <br />s2 <br />000 <br />000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG <br />, <br />, <br />s210001000 <br />POLICY JPERCOT- X LOC <br />AUT <br />OMOBILE LIABILITY <br />' <br />COMBINED SINGLE LIMIT <br />$1 <br />000 <br />000 <br />A <br />X <br />ANY AUTO <br />H)OC80912191 <br />11/01/09 <br />11/01/10 <br />(Ea accident) <br />, <br />, <br />X <br />ALL OWNED AUTOS <br />- <br />BODILY INJURY <br />$ <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 D <br />AMAGE <br />$ <br />(Per accident) <br />GARAGE LIABILITY <br />AUTO ONLY - EA ACCIDENT <br />$ <br />ANY AUTO <br />EA ACC <br />OTHER THAN <br />$ <br />AUTO ONLY: AGG <br />$ <br />EXCESSIUMBRELLA LIABILITY <br />EACH OCCURRENCE <br />s25,000,000 <br />A <br />X OCCUR E~ CLAIMSMADE <br />XAU71796700 <br />11/01/09 <br />11/01/10 <br />AGGREGATE <br />$ <br />DEDUCTIBLE <br />- <br />$ <br />RETENTION $ <br />$ <br />WORKERS COMPENSATION AND <br />' <br />A U- <br />TORYS LIMITS ER <br />EMPLOYERS <br />LIABILITY <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />E.L. EACH ACCIDENT <br />$ <br />OFFICER/MEMBER EXCLUDED? <br />If <br />e <br />i <br />_E:L. DISEASE- EA EMPLOYEE <br /> <br />s, descr <br />be under <br />Y <br />SPECIAL PROVISIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />OTHER <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br />RE: All Operations. <br />UtK I11-16AI t MULUtK CANCELLATION <br />CITEU04 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />City of Eugene DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN <br />Public: Works Dept. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />Attn: Jackie Hallett <br />1820 Roosevelt Blvd - IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />Eugene OR 97402 REPRESENTATIVES. <br />11 1 %,J ~ - <br />ACORD 25 (2001108) © ACORD CORPORATION 1988 <br />