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THIS CERTIFICATE ISSUED AS A MA' <br />INSURANCE POLICY AND DOES NOT <br />.TION. ONL <br />OR ALTER <br />of <br />This is to Certify that <br />FEugene Sand Construction, Inc. <br />PO Box 1067 NAME AND <br />ADDRESS <br />Eugene, OR 97440 <br />OFINSURED <br />L <br />THIS CERTIFICATE IS NOT AN <br />Liberty <br />Mutual <br />is, at tite issue date of this certificate, insured by the Company under the policy(ies) listed below. The insurance afforded by the listed policy(ie-s) is subject to all their terms, <br />exclusions and <br />n__~:.:__.. -..a -t.-ma r.., m..,dro..,-nt t-e,n - 1-Atti„o W- o i-I nr ntl,- Andnment with resoect to which this certificate may be issued. <br />EXP DATE <br />❑ CONTINUOUS <br />TYPE OF POLICY <br />❑ EXTENDED <br />POLICY NUMBER <br />LIMIT OF LIABILITY <br />Q POLICY TERM <br />WORKERS <br />9/1/2010 <br />WA7-13813-004095-029 <br />COVERAGE AFFORDED UNDER <br />WC LAW OF THE FOLLOWING <br />EMPLOYERS LIABILITY <br />WC7-C85-004095-019 <br />STATES: <br />COMPENSATION <br />ALL STATES EXCLUDING <br />Bodily Injury by Accident <br />MONPOLISTICS STATES AND <br />$1,000,000 Each Accident <br />NY <br />Bodily Injury by Disease <br />WI <br />OR <br />$1,000,000 Policy Limit <br />, <br />Bodily Injury by Disease <br />$1,000,000 Each Person <br />General Aggregate- Other than Products / Completed Operations <br />GENERAL LIABILITY <br />911/2010 <br />TB2-C85-004095119 <br />$2,000,000 <br />Q OCCURRENCE <br />Products / Completed Operations Aggregate <br />$2,000,000 <br />❑ CLAIMS MADE <br />Bodily Injury and Property Damage Liability <br />$2,000,000 Per Occurrence <br />RETRO DATE <br />Personal Injury <br />Included* Per Person/Organization <br />otn <br />Included in BI/PD Liability <br />FIRE DAMAGE $100,000;PER <br />PROJECT AGGREGATE <br />AUTOMOBILE <br />9/112010 <br />AS2-08,5-004095-129 <br />acngle <br />$2,000,000 B And PDiCo binedmtt <br />LIABILITY <br />Each Person <br />Q OWNED <br />Each Accident or Occurrence <br />Q NON-OWNED <br />Q HIRED <br />Each Accident or Occurrence <br />OTHER <br />Evidence of coverage <br />9/1/2010 <br />Auto: Comp Ded $10,000/Coil Ded $10,000 <br />ADDITIONAL COMMENTS <br />City of Eugene is named as additional insured with respect to Pavement Bond Measure on Willamette Street from 46th Avenue to 52nd Avenue (Job <br />No. 4582). This policy shall be primary and non-contributory. <br />If the certificate expiation date is continuous or extended term, you Will be notified if coverage is terminated or reduced before the certificate expiration date. <br />SPECIAL NOTICE-OHIO: ANY PERSON WHO, WITH INTENT TO DEFRAUD OR KNOWING THAT HE IS FACILITATING AFRAUD AGAINST AN INSURER, SUBMITS <br />AN APPLICATION OR FILES A CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT IS GUILTY OF INSURANCE FRAUD. <br />IMPORTANT NOTICE TO FLORIDA POLICYHOLDERS AND CERTIFICATE HOLDERS: IN THE EVENT YOU HAVE ANY QUESTIONS OR NEED INFORMATION ABOUT <br />INS CERTIFICATE FOR ANY REASON, PLEASE CONTACT YOUR LOCAL SALES PRODUCER WHOSE NAME AND TELEPHONE NUMBER APPEARS IN THE LOWER <br />RIGHT HAND CORNER OF THIS CERTIFICATE. THE APPROPRIATE LOCAL SALES OFFICE MAILING ADDRESS MAY ALSO BE OBTAINED BY CALLING THIS NUMBER. <br />Liberty Mutual <br />Insurance Group <br />NOTICE OF CANCELLATION: (NOT APPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW.) <br />BEFORE THE STATED EXPIRATION DATE THE COMPANY WILL NOT CANCEL OR REDUCE THE <br />INSURANCE AFFORDED UNDER THE ABOVE POLICIES UNTIL AT LEAST 30 DAYS NOTICE <br />NCELLATION HAS BEEN MAILED TO: <br />OF SUCH C <br />A <br />E <br />C <br />ity of <br />ugene <br />Judith <br />Balazentis <br />0 99 E. Broadway, Suite 400 Pittsburgh 10387 AUTHORIZED REPRESENTATIVE <br />v x Eugene, OR 97401 12 Federal Street, Ste. 310 <br />Pittsburgh PA 15212-5706 412-231-1331 <br />4/9/10 <br />OFFICE PHONE <br />DATE ISSUED <br />This certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurance as is afforded by those Companies NM 772 <br />