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EXHIBIT C <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. <br />This certificate does not amend, extend or alter the coverage afforded by the policies listed below. <br />PROJECT: <br />CERTIFICATE HOLDER&ADDITIONAL INSURED: City of Orono <br />ADDRESS: <br />ARCH/ENGR: <br />INSURED: <br />ADDRESS: <br />AGENT: ADDRESS: <br />WORKERS' COMPENSATION COVERAGE <br />POLICY# EFFECTIVE DATE / /EXPIRATION <br />DATE / / <br />INSURANCE COMPANY: <br />COVERAGE-Workers' Compensation, Statutory. Employer' 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 <br />DATE / / <br />INSURANCE COMPANY: <br />Claims Made ( )Occurrence ( )Owners&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 />235929v3