GJN4585 CPM 2009-00020 - Laserfiche WebLink

New Search

f Certificate of Insurance THIS CERTIFICATE ISSUED AS A MATTEit OF INFORMATION. ONLY ANDCONFERS NO RIGHT UPQPkY01'f~TAE"CBRTIF!'CATE Hp1,DER. THIS CERTIFICATE IS NOT AN INSURANCE POLICY AND DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW. This is to Certify that I Egge Sand & Gravel CPM Development Corporation dba NAME Arm ~~Q 90520 Coburg Rd. ADDRESS j,J ~r Eugene, OR 97408 ~ OF INSURED Mu:tual~ 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 al[ their terms, exclusions and Conditions aad is not altered b an uiremenk term or condition of an contract or other doctunent with res ect to which this certificate ma be issued. EXP DATE TYPE OF POLICY 0 CONTINUOUS D EXTENDED POLICY NUMBER LIMIT OF LIABILITY Q POLICY TERM ~'F'O~E~ 9/1 /2009 WA7-C8p-004095-028 COVERAGE AFFORDED UNDER WC7-C85-004095-018 WC LAW OF THE FOLLOWING EMPLOYERS LIABILITY COMPENSATION STATES: ALL STATES EXCLUDING Bodily Injury by Accident MONPOLISTICSSTATESAND $1,000,OOOEachAccident NY Bodily Injury by Disease OR, WI $1,000,000 Policy Limit Bodily Injury by Disease $1,000,000 Each Person GENERAL LL~BILITY 9/1 /2009 TB2-C85-004095-118 General Aggregate -Other than Products /Completed Operations Q OCCURRENCE Products /Completed Operatio ~Aggre00,000 $2,000,000 ? CLAIMS MADE Bodily Injury and Property Damage Liability RETRODATE $'2,000,000 Per Occurrence Personal Injury InClUded* Per Person/Organization Other Other Included in BI/PD Liability FIRE DAMAGE $100,000;PER PROJECT AGGREGATE AUTOMOBILE 9/1/2009 AS2-C85-004095-128 $2,000,000 B a arm combinedmit LIABILITY Q OWNED Each Person A NON-OWNED Each Accident or Occturence Q HIRED Each Accident or Occtrrence OTHER ' 9/1/2009 Auto: Comp Ded $10,000/Coil Ded $10,000 Evidence of coverage ADDITIONAL COMMENTS Certificate holder is named as additional insured with respect to Bailey Hill Road - W. 18`h Ave. to Bertelson Road project. This insurance is primary and non-contributory. Includes Waiver of Subrogation. Per project aggregate applies. If the certificate expiration date is continuous or extended term, you will be notified if coverage is terminated or reduced before the certificate expiration data ' SPECLIL NOTICE•OHIO:-ANY PERSON WHO, WITH INTENT TO DEFRAUD OR KNOWING THAT HE IS FACILITATING A FRAUD AGAINST AN INSURER, SUBMITS AN APPLICATION OR FILES A CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT IS GUILTY OF INSURANCE FRAUD, i1NPORTANT NOTICE TO FLORIDA POLICYHOLDERS AND CERTIFICATE HOLDERS: IN THE EVENT YOU HAVE ANY QUESTIONS OR NEED INFORMATION ABOUT THIS CERTIFICATE FOR ANY REASON, PLEASE CONTACT YOUR LOCAL SALES PRODUCER WHOSE NAME AND TELEPI•IONE NUMBER APPEARS IN THE LOWER ' RIGFTr HAND CORNER OF THIS CERTIFICATE, THE APPROPRIATE LOCAL SALES OFFICE MAILING ADDRESS MAY ALSO BE OBTAINED BY CALLING THIS NUMBER. L?berty Mutual NOTICE OF CANCELLATION; (NOT APPLICABLE UNLESS A NUMBER OF DAYS iS ENTERED BELOW.) Insurance Group BEFORETHE STATED EXPIRATION DATE THE COMPANY WILL NOT CANCEL OR REDUCE THE INSURANCE AFFORDED UNDER THE ABOVE POLICIES UNTIL AT LEAST 30 DAYS NOTICE OF SUCH CANCELLATION HAS BEEN MAILED TO: City of Eugene 99 E. Broadwa Suite 4Q0 ~ i~% Y, w o Eugene, OR 97401 ~ Judith Balazentis x ~ ~ PlttSbUrgh / 0387 AUTHORIZED REPRESENTATIVE 12 Federal Street, Ste. 310 Pittsburgh PA 15212-5706 412-231-1331 4/30/09 OFFICE PHONE DATE ISSUED This certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurance as is afforded by those Companies NM 772