GJN4608 Eugene Sand 2010-00007 - 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 INSURANCE POLICY AND DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW. This is to Certify that Eugene Sand Construction, Inc. • B ~ NAME AND PO ox 1067 ADDRESS ~ ~ Leber Eugene, OR 97408 : ~ ~ OF INSURED Mutual® 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 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 ? CONTINUOUS TYPE OF POLICY ? EXTENDED POLICY NUMBER LIMIT OF L][A$ILITY I~ POLICY TERM WA7-C8D-004095-029 COVERAGE AFFORDED UNDER WORKERS 9/1 /2010 WC7-C85-004095-019 WC LAW OF THE FOLLOWING EMPLOYERS LIABILITY COMPENSATION STATES: ALL STATES EXCLUDING Bodily Injury by Accident MONPOLISTICS STATES AND 1,000,000 Each Accident NY Bodily Injury by Disease OR, WI $1,000+000 Policy Limit Bodily Injury by Disease $1, 000, OOO Each Person GENERALLIA$ILITY 9/1/2010 7B2-C85-004095-119 General Aggregate-OtherthanProducts7Compteted`Operations $2,000,000 Q 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 Ineluded* Per Person/Organization Other Other Included in BI/PD Liability FIRE DAMAGE $100,000;PER PROJECT AGGREGATE AUTOMOBILE 9/1 /2010 AS2-C85-004095-129 $2, 000,000 B j ~eepDntCo b nedmit LIABILITY Each Person ~I OWNEp 0 NON-OWNED Each Accident or Occurrence 0 HIRED Each Accident or Occurrence OTHER Evidence of coverage 9/1/2010 Auto: Comp Ded $10,000/Coil Ded $10,000 ADDITIONAL COMMENTS The City of Eugene is named as additional insured with respect to the Echo Hollow Tennis Court Overlay Project (Contract No. 2010-00007). This insurance is primary and non-contributory. Includes Waiver of Subrogation. Per project aggregate applies. IF the certificate expiration dale is continuous or exrended term, you will be notified if coverage is terminated or reduced before the certificaro expiration date. SPECIAL NOTICE-OHIO: ANY PERSON WHO, WITH INTENT TO DEFRAUD OR KNOWMG THAT HE IS FACILITATING A FRAUD AGAINST AN INSURER, SUBMITS AN APPLICATION OR FILES A CLAIM CON1'AHVMG A FALSE OR DECEPTIVE STATEMENT IS GUILTY OF INSURANCE FRAUD. IMPORTANT NOTICE TO FLORD)A POLICYHOLDERS AND CERTIFICATE AOLDERS: M THE EVENT YOU HAVE ANY QUESTIONS OR NEED INFORMATION ABOUT THTS CERTIFICATE FOR ANY REASON, PLEASE CONTACT YOUR LOCAL SALES PRODUCER WHOSE NAME AND TELEPHONE NUMBER APPEARS IN THE LOWER RIGHT HAND CORNER OF THIS CERTIFICATE. THE APPROPRIATE LOCAL SALES OFFICE MA[LING'ADDRESS MAY ALSO BE OBTAINED BY CALLING THIS NUMBER. Liberty MUtDaI Insurance Group NOTICE OF CANCELLATION: (NOT APPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW.) BEFORE THE STATED EXPll2AT10N 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 T0: v ' Cit of Eu ene ~ ~ ~ ~ Judith Balazentis c o 99 E. Broadway, #400 Pittsburgh / 0387 AUTHORIZED REPRESENTATIVE v ~ Eugene, OR 97401 12 Federal Street, Ste. 310 Pittsburah PA 15212-5706 412-231-1331' 9/21/09 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