GJN4612 Eugene Sand 2010-00005 - Laserfiche WebLink

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Certificate of Insurance THIS CERTIFICATE ISSUED AS A MATTER OF INFORMATION. ONLY AND CONFERS NO RIGHT UPON YOU THE CERTIFICATE HOLDER. THIS CERTIFICATE IS NOT AN - fNSURANCE POLICY AND DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW. i This is to Certify that Eugene Sand Construction, Inc. ~ ~ PO BOX 1067 NAME AND T I~ A~ Eugene, OR 97440 ADDRESS j1 e OF INSURED ~ a® is, at the issue date of this certificate, insured by the Canpany under the policy(ies) listed below. The insurance afforded by the listed policy(ies) is subject to all their terms, exclusions and Conditions and is not altered b an re uirement, term or condition of an contract or other document with res ect to which this certificate ma be issued. EXP DATE l ~ ? CONTINUOUS TYPE OF POLICY ? EXTENDED POLICY NUMBER LIMIT OF LIABILITY Q POLICY TERM WORKERS 9/1!2010 WA7-C8D-004095-029 wciwoFTHEFOLt,owI~NGR EMPLOYERS LIABILITY COMPENSATION WC7-C85-004095-019 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 LIABILITY General Aggregate - Otlter than Products /Completed Operations 9/1/2010 TB2-C85-004095-119 $2,000,000 ~ OCCURRENCE Products /Completed Operations Aggregate $2,000,000 ? CLAIMS MADE Bodily Injury and Property Damage Liability $2,000,000 Per Occurrence RETRO DATE Personal Injury Included* Per Person/Organization Other Other Included in BI/PD Liability FIRE DAMAGE $100,p00;PER PROJECT AGGREGATE AUTOMOBILE 9/1/2010 AS2-C85-004095-129 $2,000,000 B~ And P.D.tCombinedmtt LIABILITY - d OWNED Each Person Q NON-OWNED Each Accident or Oceutrenee Q HIRED Each Accident or Occurrence OTHER Evidence of coverage 9/1 /2010 Auto: Comp Ded $10,000/Coil Ded $10,000 ADDITIONAL COMMENTS Certificate holder is named as additional insured with respect to the Aiton Baker Park -Lot 8; Job #4612. Thls 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 date. SPECIAL NOTICE-OHIO: ANY PERSON WHO, WITH IMENT TO DEFRAUD OR KNOWING THAT FIE 1S FACILITATING A FRAUD AGAINST AN INSURER, SUBMITS AN APPLICATION OR PILES A CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT i5 GUH.TY OF INSURANCE FRAUD. IMPORTANT NOTTCE TO FLORIDA POLICYIiOLDERS AND CERTIFfCATE HOLDERS: M THE EVENT YOUHAVE ANY QUESTIONS OR NEED INFORMATION ABOUT THIS CERTIFICATE FOR ANY REASON, PLEASE CONTACT YOUR LOCAL SALES PRODUCER ~YfiOSE NAME AND TELEPHONE NUMBER APPEARS IN THE LOWER RIGHT HAND CORNER OR THIS CERTIFICATE. TIME APPROP2IATE LOCAL- SALES OFFICE MAILING ADDRESS MAY ALSO SE OBTAINED BY CALLING THIS NUMBER. Liberry MUIUaI Insurflnce Group NOTICE OF CANCELLATION: (NOT APPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW.) BEFORE THE 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 ~ i a 99 E. Broadway, Suite 400 ~ 3' ~ " Eu ene OR 97401 Judith Balazentis U x g ' Pittsburgh / 0387 AUTHORIZED REPRESENTATIVE 12 Federal Street, Ste. 310 Pittsburah PA 15212-5706 412-231-1331 8/14/09 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