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AC CN?h P CERTIFICATE OF LIABILITY INSURANCE <br />L6"15/2011 ATE(MM /DDIYYYY) <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />NAME: <br />PHONE FAX <br />Ac No EXM541- 741 -0550 Arc No:S -711-167 4 <br />KPD Insurance <br />PO BOX 784 <br />Springfield OR 97477 <br />E -MAIL <br />ADDRESS: <br />INSURER(S) AFFORDING COVERAGE <br />NAIC A <br />EACH OCCUDDENCE <br />INSURERA:SAIF Corporation <br />36196 <br />$ <br />INSURED INTEI5W <br />INSURER B: <br />PERSONAL 8 ADV INJURY <br />INSURER C: <br />Integrated Electronic Systems, Inc. <br />INSURER D: <br />$ <br />PO BOX 708 <br />Eugene OR 97440 - 0708 <br />- <br />INSURER E: <br />$ <br />INSURER F: <br />$ <br />COVERAGES CERTIFICATE NUMBER: 612406144 REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />GEFtTIFIGATE.nnAY 5E 1 t Q On nnnY,- rnmT.—am -Tm' w'.5U!tAIVG€ AFFOFt ^ED 5Y-THE HE.nE!IJJ 15 51J5J1M'`.T TO ALL T.HE T €€tMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />INSR <br />S BR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MM /DD /YYYY <br />POLICY EXP <br />MM /DWYVYV <br />LIMITS <br />GENERAL LIABILITY <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE E] OCCUR <br />EACH OCCUDDENCE <br />$ <br />DAMA N <br />PREMISES Ea occurrence <br />$ <br />MED EXP (Any one Person) <br />$ <br />PERSONAL 8 ADV INJURY <br />$ <br />GENERAL AGGREGATE <br />$ <br />G N1 AGGREGATE I IMIT APPI IFS PFR <br />r'OLICV PRO LOC <br />PRODUCTS - COMP /OP A <br />$ <br />$ <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />ALLOWNED SCHEDULED <br />AUTOC AUTOC <br />NON -OWNED <br />HIRED AUTOS AUTOS <br />Ea accident <br />ROn Il Y IN.IIIRY (Per person) <br />$ <br />BODILY INJURY (Pay a —d-1) <br />$ <br />PROPERTY <br />$ <br />UMBRELLA U <br />EXCESS LIAB <br />OCCUR <br />CI AIMS -MAnF <br />EACH OCCURRENCE <br />$ <br />AGGRFGATF <br />R <br />DCD RCTCNTION$ <br />$ <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? ❑ <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />977562 <br />/1/2011 <br />/1/2012 <br />X TORY U OR <br />E.L. EACH ACCIDENT <br />$500,000 <br />E.L. DISEASE - EA EMPLOYEE <br />$500,000 <br />E.L. DISEASE - POLICY LIMIT <br />$500,000 <br />DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />Re: Contract # 2009 - 00404 <br />UtM 1 II I t HULL)LK l.Arvla LLA I IUDI <br />City of Eugene Public Worke Maintenance <br />1820 Roosevelt Blvd <br />Eugene OR 97402 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORnANCF WITHTHF P011CV PROVISIONS <br />AUTHORIZED REPRESENTATIVE <br />01988-2010 <br />reserved. <br />ACORD 25 (2010/05) <br />The ACORD name and logo are registered marks of ACORD <br />