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<br />`~~ A~ORD CERT9~iCATE OF LlA~ILI~'Y IIVSUF~~4NCE - DATE (MM/DD/YYYY) <br />H~°co 1 oa 26 os <br />PROOUC~'R THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Anchor Insurance - Eugene HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />450 Country Club Rd. Suite 100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Eugene OR 97401 <br />Phone: 541-342-4400 Fax: 541-344-5731 INSURERS AFFORDING COVERAGE NAIC # <br />INSURED INSURER A: Ohio Casualty Insurance Co. <br /> INSURER B: American Fire 6 Casualty Co. <br />H & J Construction <br />Ina. INSURER C: Ox contractors wrke comp Trust <br />, <br />PO BOX 2432 <br />7402 INSURER D: c/o Empire Pacific Riak Mgmt. <br />Eugene OR 9 <br /> wsuRER E: New York Marine & General <br />COVERAGES <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 />LTR NSR TYPE OF INSURANCE <br />POLICY NUMBER <br />DATEYMM DDIYY <br />PDATE MMIDDIYYO <br />LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ $1 , OOO , OOO <br />A X COMMERCIAL GENERAL LIABILITY BKO (OS) 53536382 11/22/07 11/22/08 PREMISES Eaoccurence $ $100,000 <br /> CLAIMS MADE X^ OCCUR MED EXP (Any one person) $ $1 O , OOO <br /> X $2,000 PD Ded. PERSONALBADVINJURY $$1,000,000 <br /> X Jobsite Poll . Inc GENERAL AGGREGATE $ $2 , OOO , OOO <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ $2 , O OO , OOO <br /> POLICY X PRO LOC <br />JECT <br /> AUT OMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />$ $1 <br />OOO OOO <br /> (Ea accident) , <br />B X ANY AUTO BAA (08) 53536382 11/22/07 11/22/08 <br /> ALL OWNED AUTOS <br />BODILY INJURY <br />$ <br /> SCHEDULED AUTOS (Per person) <br /> X HIRED AUTOS BODILY INJURY <br />$ <br /> X NON-OWNED AUTOS (Per accident) <br /> X B . Auto Poll Inc . PROPERTY DAMAGE <br />$ <br /> (Per accident) <br /> GARAGE LIA8ILITY AUTO ONLY - EA ACCIDENT $ <br /> ANY AUTO OTHER THAN EA ACC $ <br /> AUTO ONLY: AGG $ <br /> EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ $3 , OOO , OOO <br />A X OCCUR ~ CLAIMSMADE USO (OB) 53536382 11/22/07 11/22/08 AGGREGATE $ $3,000,000 <br /> <br /> DEDUCTIBLE $ <br /> RETENTION $ $ <br /> WORKERS COMPENSATION AND X TORY LIMITS ER <br />C EMPLOYERS'LIABILITY <br />VE 026-WC07-0825 (SIG) 10/01/07 10/01/08 E.L. EACH ACCIDENT $2,000,000 <br />E ANY PROPRIETOR/PARTNER/EXECUTI <br />OFFICER/MEMBER EXCLUDED? MWl OOOO 6 (XS) E.L. DISEASE - EA EMPLOYEE $ 2 , O OO , OO O <br /> If es, describe under <br />SPECIAL PROVISIONS below <br />E.L. DISEASE -POLICY LIMIT <br />$ 2 OOO OOO <br /> OTHER <br />DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />The City of Eugene, its officials, employees, servants and agents <br />are Additional Insureds as respects General Liability per form CG 85760505 <br />pages 2-8 attached; Coverages are Primary and limits shall apply per project <br />(page 5); Automobile Additional Insured form CA2048- Designated Insured. <br />RE: Contract 2009-00005/ Job #4544 Tonawanda Pump Station Capacity Upgrades <br />rFaTlFlr_eTF unl nFR CANCELLATION <br />CITYO-3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br /> DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O DAYS WRITTEN <br />The City Of Eugene NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />Ari Oregon Municipal COrp . IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />244 East Broadway <br />ene OR 97401 <br />Eu REPRESENTATIVES. <br />g <br />A IZED REPR ATp~v <br />~/~ <br />ACORD 25 (2001 /08) v ta.vrcu ~.vrcrvrw r wig r aoo <br />