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~YYJ~iiL TM CERTIFICATE OF LIABILITY INSURANCE 6/19/2009) <br /> PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br /> C.A. Tomassene & Son, LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br /> 707 S.W. Washington St Suite 1418 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br /> ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br /> P®xtland, OR 97205 <br /> 503-226-3741 INSURERS AFFORDING COVERAGE NAIC# <br /> INSURED KSH CONSTRUCTION CO . , INC . INSURER A: LIBERTY NORTHWEST INSURANCE <br /> INSURER B: <br /> <br /> ! P . O . BOX 214 31 INSURER C: <br /> KEIZER, OR 97307 INSURER D: <br /> INSURER E: <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 /> INSR o~~ POLICY EFFECTIVE POLICY EXPIRATION <br /> LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DD/YY LIMITS <br /> GENERAL LIABILITY EACH OCCURRENCE $ 1, 000, 000 <br /> X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence $ 10 ~ , ~ 0 0 <br /> CLAIMS MADE CI OCCUR MEDEXP(Anyaneperson) $ 5, 000 <br /> A X C05 16-42-95 8/22/09 8/22/10 PERSONALaADVINJURY $ 1, 000, 000 <br /> ~ GENERAL AGGREGATE $ 2, OOO, OOO <br /> GEN'LAGGREGATELIMITAPPLIESPER PRODUCTS-COMP/OPAGG $ 2,000,000 <br /> POLICY ~ E <br /> ~ LOC <br /> AUTOMOBILE LIABILITY <br /> COMBINED SINGLE LIMIT $ <br /> ANYAUTO (Ea accident) <br /> ALL OW NED AUTOS BODILY INJURY <br /> SCHEDULED AUTOS (Per person) $ <br /> HIRED AUTOS <br /> BODILY INJURY $ <br /> NON-OW NEDAUTOS (Peraccident) <br /> PROPERTY DAMAGE $ <br /> (Peraccident) <br /> GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ <br /> ANYAUTO OTHERTHAN EAACC $ <br /> AUTOONLY: AGG $ <br /> EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ <br /> OCCUR ~ CLAIMS MADE AGGREGATE $ <br /> DEDUCTIBLE $ <br /> RETENTION $ $ <br /> WORKERS COMPENSATIONAND WCSTATU- OTH- <br /> EMPLOYERS' LIABILITY TORYLIMITS ER <br /> E.L. EACH ACCIDENT $ <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE <br /> OFFICERIMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYE $ <br /> Ifyes,describeunder <br /> SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ <br /> OTHER <br /> A LEASED OR RENTED C05 16-42-95 8/22/09 8/22/10 $100,000 <br /> EQUIPMENT <br /> DESCRIPTION OFOPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BYENDORSEMENT /SPECIAL PROVISIONS <br /> RE: PROJECT # 4602 - PMB AMAZON PATH REHABILITATION PROJECT E'ROM 19TH TO 31ST AVE. <br /> THE CITY OF EUGENE, AN OREGON MUNICIPAL CORPORATION, ITS OFFICERS, AGENTS AND <br /> EMPLOYEES, ARCHITECT/ENGINEER AND THEIR RESPCETIVE OFFICERS ARE NAMED AS <br /> ADDITIONAL INSURED. <br /> CERTIFICATE HOLDER CANCELLATION <br /> THE CITY OF EUGENE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO <br /> 99 E . BROADWAY, SUITE #4OO DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3~ DAYS WRITTEN <br /> EUGENE , OREGON 97 4 01 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHAL <br /> IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br /> ATTN: MARK SCHOENING, CITY ENGINEER REPRESENTATIVES. <br /> FAX # 5 41- 6 8 2 - 8 410 AUTHORIZED REPRESENTA <br /> • <br /> ACORD25(2001/08) ©ACORD CORPORATION 1988 <br /> <br />