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ACCRD CERTIFICATE OF LIABILITY INSURANCE OP ID DATE(MMIDDmYY) <br /> H&JCO-1 06 10 09 <br /> PRODUCER 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 /> <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: B1tumlriouS Casualty Co <br /> INSURER B: R$UI Indemnit Company <br /> H & J Construction, Iria. INSURER C: OR Contractors Wrks Comp Trust <br /> PO BOX 2432 INSURER D: c/o sickmore Risk Services OR <br /> Eugene OR 97402 <br /> INSURER E: Safety National Casualty Corp. <br /> COVERAGES <br /> <br /> it 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 W ITH RESPECT TO W HICH 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 /> POLICY NUMBER POLICY EFFECTIVE POLI Y EXPIRATI N LIMITS <br /> LTR NSR TYPE OF INSURANCE DATE MMIDD/YY DATE MMIDD/YY <br /> GENERAL LIABILITY EACH OCCURRENCE $ $1 , OOO , OOO <br /> A X COMMERCIAL GENERAL LIABILITY CLP3258968 11/22/08 11/22/09 PREMISES (Eao~ccnurence) $ $100,000 <br /> CLAIMS MADE X? OCCUR MED EXP (Any one person) $ yS` 10 , 00 0 <br /> X $2,000 PD Ded. PERSONAL&ADVINJURY $ $1,000,000 <br /> X Jobsite Poll . Inc GENERAL AGGREGATE $ $2 , OOO , OOO <br /> GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OPAGG $ $2,000,000 <br /> POLICY X JECT LOC <br /> AUTOMOBILE LIABILITY <br /> A X ANY AUTO CAP3526150 11/22/08 11/22/Og COMBINED SINGLE LIMIT $ $1 000 OQQ <br /> (Ea accident) ~ ~ <br /> ALL OWNED AUTOS <br /> BODILY INJURY $ <br /> SCHEDULED AUTOS (Per person) <br /> X HIRED AUTOS <br /> BODILY INJURY $ <br /> X NON-OWNED AUTOS (Per accident) <br /> X B . Auto POl l InC . PROPERTY DAMAGE $ <br /> (Per accident) <br /> GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ <br /> ANY AUTO OTHER THAN ~ ACC $ <br /> AUTO ONLY: qGG $ <br /> EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ $3 , 000 , 000 <br /> A X OCCUR ~ CLAIMSMADE CUP2563150/(B) NxAZZZ~ss 11/22/08 11/22/09 AGGREGATE $ $3,000,000 <br /> First $1M $Bituminous <br /> DEDUCTIBLE X$ $2MM $ RSUI Ind (B) <br /> X RETENTION $1 O , OOO $ <br /> WORKERS COMPENSATION AND X TORY LIMITS ER <br /> C EMPLOYERS'LIABILITY 026-WC07-0825 (SIG) 10/01/08 10/01/09 E.L. EACH ACCIDENT $ 2 000 000 <br /> E OFFICER/MEMBER EXCLUDED? ECUTIVE ~ ~ <br /> AGC-2S57-OR (XS) E.L.DISEASE-EAEMPLOYEE$2,000,000 <br /> If yes, describe under <br /> SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ 2 , 000 , 000 <br /> OTHER <br /> DESCRIPTION OF OPERATIONS (LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS <br /> The City of Eugene, its officials, employees, servants and agents <br /> are Additional Insureds per form GL-3085 (01/06). Coverages <br /> are Primary and limits are per project. <br /> RE: Contract 2008-29 / Job #4507 / Project: 2009 Wastewater Point Repairs <br /> at Various Locations in the City (Contract 2009-00024) Job # 4594 <br /> CERTIFICATE HOLDER CANCELLATION <br /> CITYE-1 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 /> CITY OF EUGENE NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br /> Public Works/ Engirieeririg IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br /> 99 E. Broadway, Suite 400 <br /> Eugene OR 97401 REPRESENTATIVES. <br /> A (ZED REPR /~ATpw ! . <br /> r <br /> ACORD 25 (2001/08) ©ACORD CORPORATION 1988 <br /> <br />