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TE HOLDER. THIS CERTIFICATE IS NOT AN <br />BELOW. <br />This is to Certify that <br />( <br />I Egge Sand & Gravel <br />NAME A <br />T <br />CPM Development Corporation dba ~~e~~-.~ T <br />ND <br />' <br />a <br />90520 Coburg Rd. ADDRESS <br />te <br />L (, y <br />Eugene, OR 97408 ~ OF INSURED J <br />Mutual® <br />is, at the issue date of this certificate, insured by the Company under the policy(ies) listed below. The insurance afforded by the listed policy(ies) is subject to all their terms, exclusions and <br />- - - - ---- --- -- ------ <br />EXP DATE °-- -- -.. _........_..,..,..._ .................... ....~a ~. w w~~c~ uus ccmncaw ma o0 4csuea. <br /> ^ CONTINUOUS <br />TYPE OF POLICY ^ EXTENDED POLICY NUMBER LIMIT OF LIABILITY <br /> D POLICY TERM <br />~rO~RS 9/1 /2009 WA7-C8D-004095-028 w <br />R <br /> <br />COMPENSATION <br />WC7-C85-004095-018 C LAW OF THE OLLOWING <br />STATES: EMPLOYERS LIABILITY <br /> ALL STATES EXCLUDING Bodtly[njurybyAccident <br /> MONPOLISTICS STATES AND $1,000,000 Each Accident <br /> NY Bodily Injury by Disease <br /> oR, WI $1,000,000 Policy Limit <br /> Bodily Injury by Disease <br /> $1,000,000 Each Person <br />GENERAL LIABILITY 911 /2009 T62-C85-004095-118 General Aggregate - Other than Products /Completed Operations <br /> $2,000,000 <br />Q OCCURRENCE Products /Completed Operations Aggregate <br /> $2,000,000 <br />^ CLAIMS MADE Bodily Injury and Property Damage Liability <br /> <br />RETRO DAT $2,000,000 Per Occurrence <br /> E Personal Injury <br /> Included* Per Person/Organization <br /> Other Other <br /> Included in BI/PD Liability FIRE DAMAGE $100,000;PER <br /> PROJECT AGGREGATE <br />AUTOMOBILE 9/1 /2009 AS2-C85-004095-128 $2,000 <br />000 <br />dot <br />LIABILITY , <br />g L And P.D. Combu <br /> <br />0 OWNED Each Person <br />Q NON-OWNED Each Accident or Occurrence <br />Q HIRED <br /> Each Accident or Occurrence <br />OTHER <br /> 9/1/2009 Auto: Comp Ded $10,000/Coil Ded $10,000 <br />Evidence of coverage <br />ADDITIONAL COMMENTS <br />Certificate Holder is named as additional insured with respect to 2008 Pothole Repair Project -Job No. 4588. Thls insurance is primary and non- <br />contributory. Includes waiver of subrogation. Per project aggregate applies. <br />•Ifthecerfiacateemuationdateismntinnmsnre.r".d...1r..,....~r...,:uti...,..:a.a:r.,....-...._:..~:__._.____..__~~_~___.._ ..,. -. <br />SPECIAL NOTIC&OAlO: ANY PERSON WHO, WITH INTENT TO DEFRAUD OR KNOWING THAT HE IS FACILITATING A FRAUD AGAINST AN INSURER, SUBMITS <br />AN APPLICATION OR FILES A CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT IS GUILTY OF INSURANCH FRAUD. <br />IMPORTANT NOTICE TO FLORIDA POLICYHOLDERS AND CERTIFICATE HOLDERS: IN THE EVENT YOU HAVfi ANY QUESTIONS OR NEED INFORMATION ABOUT <br />THIS CERTIFICATE FOR ANY REASON, PLEASE CONTACT YOUR LOCAL SALES PRODUCER WHOSE NAME AND TELEPHONE NUMBER APPEAR8 IN TAE LOWER <br />RIGHT HAND CORNER OF THIS CERTIFICATE. THE APPROPRIATE LOCAL SALES OFFICE MAILING ADDRESS MAY ALSO BE OBTAINED BY I,ALLING THIS NUMBER. Liberty Mutual <br />Insurance Group <br />NOTICE OF CANCELLATION: (NOT APPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW.) <br />BEFORE THE STATED EXPIRATION DATE THE COMPANY WILL NOT CANCEL OR REDUCE THE <br />MSURANCE AFFORDED UNDER THE ABOVE POLICIES UNTIL AT LEAST 30 DAYS NOTICE <br />OF SUCH CANCELLATION HAS BEEN MAILED TO: <br />City of Eugene ~ ~ ;%~~~ <br />a ~ 244 E. Broadway ~' <br />Eugene, OR 97401 Judith Balazentis <br />x ~ Pittsburgh / 0387 AUTHORIZED REPRESENTATIVE <br />12 Federal Street, Ste. 310 <br />J Pittsburgh PA 15212-5706 412-231-1331 9/15/08 <br />OFFICE PHONE DATE ISSUED <br />This certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurance as is afforded by those Companies NM 772 <br />