GJN4674 Eugene Sand 2010-00014 - Laserfiche WebLink

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J4• Q1l.G PHIS C I1'IFICATE ISSUED AS A MATTER OF INFORMATION. ONLY AND CONPERSNO 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. ~ PO Box 1067 NAME AND Li Mbuteru7ai Eugene, OR 97440 ADDRESS L OF INSURED® 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 terns, exclusions and Conditions and is not altered by any reouirement, tern or condit on of any contract or other document wilt respect to which this certificate may be issued. EXP DATE El CONTINUOUS TYPE OF POLICY EXTENDED POLICY NUMBER LIMIT OF LIABILITY Q POLICY TERM WORKERS 9/1/2010 WA7-C8D-004095-029 COVERAGE AFFORDED UNDER WC LAW OF THE FOLLOWING EMPLOYERS LIABILITY COMPENSATION WC7-C85-004095-019 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 $1,000,000 Each Person GENERAL LIABILITY 9/1/2010 TB2-C85-0040 5.'-l'1 'q General Aggregate - Other than Products / Completed 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 Included* 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 Each Accident-Single Limit 33 .1. And P.D. Combined LIABILITY RI OWNED Each Person Q NON-OWNED Each Accident or Occurrence Q 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 2010 Pavement Preservation Program Storm Rehabilitation at Various Locations 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 date. SPECIAL 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. IMPORTANT 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 TELEPHONE NUMBER APPEARS IN THE LOWER RIGHT HAND CORNER OF THIS CERTIFICATE. THE APPROPRIATE LOCAL SALES OFFICE MAILING ADDRESS MAY ALSO BE OBTAINED BY CALLING THIS NUMBER. Liberty Mutual Insurance 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 9 v Judith Balazentis x 99 E. Broadway, #400 Pittsburgh / 0387 AUTHORIZED REPRESENTATIVE U Eugene, OR 97401 12 Federal Street, Ste. 310 Pittsburgh PA 15212-5706 412-231-1331 3/1/10 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