GJN4617 4583 4644 Eugene Sand Contract

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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. PO Box 1067 NAME AND Liber Eugene, OR 97440 ADDRESS t~ L 1 OF INSURED mutua✓1® 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 by anv reeuirenent. tern or condition of nnv nnntract or other dnnn,nent with recnnet to wh;A, rh:, .-a.t:5o~ra - h,.:--d EXP DATE ❑ CONTINUOUS TYPE OF POLICY 0 EXTENDED POLICY NUMBER LIMIT OF LIABILITY 0 POLICY TERM WORKERS 9/1/2010 WA7-C8D-004095-029 WCCLAWOFTHE 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 000 000 Policy Limit $1 OR WI , , , Bodily Injury by Disease $1,000,000 Each Person GENERAL LIABILITY 9/1 /2010 TB2-C85-004095-119 General Aggregate -Other than Products / Completed Operations $2,000,000 0 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 911/2010 AS2-C85-004095-129 Ac-Single Li $2,000,000 Ba1.IAn dP.D.tCombnedtntt LIABILITY Each Person 0 OWNED 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 City of Eugene, its officers, agents and employees are named as additional insured with respect to 2010 Pavement Preservation Program, including Hawkins Lane - Job No. 4583, 33`d Ave - Job No. 4617 and Oakway Road - Job No. 4655 (Contract 2010-00020). Coverage is primary and non- contributory Waiver of subrogation applies. Per project aggregate applies. - if file certificate expiration date is continuous or extended term, you wdI 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 a 99 E. Broadway, Suite 400 Judith Balazentis o Eugene, OR 97401 Pittsburgh 10387 AUTHORIZED REPRESENTATIVE x 12 Federal Street, Ste. 310 Pittsburgh PA 15212-5706 412-231-1331 5/10/10 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