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• <br /> CERTIFICATE OF INSURANCE <br /> LIABILITY & WORKERS' COMPENSATION <br /> This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This <br /> certificate does not amend,extend or alter the coverage afforded by the policies listed below. <br /> PROJECT: Llama t C Yy O Old Q_. <br /> CERTIFICATE HOLDER&ADDITIONAL INSURED: City of Orono <br /> ADDRESS: <br /> ARCH/ENGR: <br /> INSURED: ADDRESS: <br /> AGENT: ADDRESS: <br /> WORKERS'COMPENSATION COVERAGE <br /> POLICY# EFFECTIVE DATE / / EXPIRATION DATE / / <br /> INSURANCE COMPANY: <br /> COVERAGE-Workers'Compensation,Statutory.Employers'Liability Limit <br /> $ Each Accident $ Disease Policy Limit $ Disease Employee Limit <br /> ($500,000 Policy limit applies to both accident and disease) <br /> GENERAL LIABILITY <br /> POLICY# EFFECTIVE DATE / / EXPIRATION DATE / / <br /> INSURANCE COMPANY: <br /> ( )Claims Made ( )Occurrence ( }Owner's&Contractors Protective ( )Other <br /> LIMITS: <br /> General Aggregate Limit(Other Than Products-Completed Operations) <br /> Products-Completed Operations Aggregate Limit <br /> Personal&Advertising Injury Limit <br /> Each Occurrence $ <br /> 180976 6/22/15 mpg 19 <br />