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Ra►® CERTIFICATE OF LIABILITY INSURANCE OP ID 7W <br />F7E ( MMIDDWYY) <br />5/21/10 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES-NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the.policy ies) must be endorsed. If. SUBROGATION IS WAIVED, subject to <br />-the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />WNIALl <br />NAME: <br />Anchor Insurance - Eugene <br />PHONE 1FAX <br />AIC, No, Ext : (AIC, No): <br />450 Country Club Rd.. Suite 1.00 <br />ADDRESS: <br />Eugene OR 97401 <br />CUSTOMERID#: H&JCO-1 <br />Phone:541-342-4400 Pax:541-.344-5731 <br />INSURER(S) AFFORDING COVERAGE <br />NAIC# <br />INSURED <br />INSURER A : Bituminous _.Casualty CO <br />H & J Construction, Inc. <br />PO <br />Box 2432 <br />INSURER B: RSUI IndeIDnlt Company <br />. <br />Eugene OR 97402 <br />INSURER C : SAIF Corporation <br />INSURER D : <br />INSURER E: <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />LTR <br />TYPE OF INSURANCE <br />INSR <br />WVD <br />POLICY NUMBER <br />(MMIDDYYYY) <br />(MMIDDIYYYY) <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ $1 , 0 0 0 , .0 0 0 <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />7 <br />CLP3269017 <br />11/22/09 <br />11/22/10 <br />'ED <br />PREMISES Ea occurrence) <br />$ $100 , 000 <br />CLAIMS-MADE ~ OCCUR <br />MED EXP (Any one person) <br />$ $10 , 000 <br />X <br />'$2,000 :PD Ded. <br />PERSONAL RADVINJURY <br />$$1,000,000 <br />X <br />Jobsite Poll. Inc <br />GENERAL AGGREGATE <br />$.$2,0!00,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS- COMP/OP AGG <br />s$2,000,000 <br />POLICY X PRO LOC <br />JECT <br />$ <br />AUT <br />OMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />000 <br />000 <br />$.$1 <br />A <br />X <br />ANY AUTO <br />CAP3534224 <br />(Ea accident) <br />, <br />, <br />. <br />ALL OWNED AUTOS <br />11/22/09 <br />11/22/10 <br />BODILY INJURY (Per person) <br />$ <br />SCHEDULED AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTY DAMAGE <br />$ <br />X <br />HIRED AUTOS <br />(Per accident) <br />X <br />NON-OWNED AUTOS <br />$ <br />X <br />B. Auto Poll Inc_ <br />$ <br />A <br />UMBRELLA LIAB <br />X <br />OCCUR <br />CUP2586449 <br />11/22/09 <br />11/22/10 <br />EACH OCCURRENCE <br />$$3,000,000 <br />EXCESS LIAB <br />CLAIMS-MADE <br />AGGREGATE <br />$$3,000,000 <br />DEDUCTIBLE <br />$ <br />X <br />RETENTION $ 10, 000 <br />$ <br />C <br />WORKERS COMPENSATION <br />744797 <br />10/01/09 <br />10/01/10 <br />X WCSTATU- - <br />AND EMPLOYERS'.LIABILITY <br />TORY LIMITS ER <br />YIN <br />ANY PROPRIETOR/PARTNER/EXECUTIV <br />OFFICER/MEMBER EXCLUDED? <br />I A <br />E.L. EACH ACCIDENT <br />$1,000,000 <br />(Mandatory in NH) <br />If <br />d <br />ib <br />E.L. DISEASE - EA EMPLOYEE <br />$1,000,000 <br />yes, <br />escr <br />e under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$1,000,000 <br />A <br />:Installation Float <br />CLP3269017 <br />11/22/09 <br />11/22/20 <br />Limit $250,000 <br />Per Occurrence <br />Deduct. $ 2,500 <br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />The City of Eugene its off' 'LM <br />em loyees and agents ar additional <br />insured <br />er form 6L 3085 <br />01/c06 <br />Wai <br />f <br />g <br />p <br />( <br />( <br />) <br />ver o <br />Subro- pg.4. <br />Per project agg <br />-Pg.7) Addi ional Insured for products and completed operations as per form <br />-4503 <br />040 <br />GL <br />( <br />7). his Insurance is rimsrryy over City's.30 Days NOC in event <br />of cancel <br />RE <br />J <br />b W4589 <br />20 <br />10 W <br />h <br />t <br />. <br />: <br />o <br />. <br />. <br />astewa <br />er Re <br />abilitation at various locations. <br />CERTIFICATE HOLDER CANCELLATION <br />EUGEN-7 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Cit <br />f <br />y o <br />Eugene <br />99 East Broadway Ste 400 <br />AUTHORIZED REPRESENTATIVE <br />Eugene OR 97401-3174 <br />©1988-2009 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD <br />