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1� CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MMIDD/YY'YY) <br />OF ID V3 <br />07 07/22/10 <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: it the certif h older Is an ADDITIONAL INSURED, the policy les must be endorsed. , 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 />NAME: <br />PHONE <br />A/L,NC Est: (ac, No): <br />Anchor Insurance - Eugene <br />ADDRESS: <br />450 Country Club Rd. Suite 100 <br />CUSTOMERIDM SITEW -1 <br />Eugene OR 97401 <br />Phone:541- 342 -4400 Fax:541- 344 -5731 <br />INSURERS) AFFORDING COVERAGE <br />NAIC If <br />INSURED <br />INSURER A: peat Aserican Insurance Co. <br />MED EXP(Any one person) <br />SiteWork Construction, Inc. <br />PO Box 70539 <br />INSURER B: Ohio Casualty Inaueanoe co. <br />$1,000,000 <br />INSURER C: cami I: Industry Inaarancs <br />Per Occurrence <br />Eugene OR 97401-0127 <br />INSURER D; <br />GEN'L AGGREGATE LIMIT APPLIES PER <br />POLICY X JECT LOC <br />PRODUCTS - COMPIOP ADD <br />INSURER E : <br />$ <br />I NSURER F: <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />NON-OWNED AUTOS <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 />MMIDDIVYVY <br />(MMIDDIYI'YY <br />LIMITS <br />A <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE ❑X OCCUR <br />X $250 PD Deduct <br />X <br />City of <br />BLW53479592 <br />07 /06/10 <br />07/06/11 <br />EACH OCCURRENCE <br />$1,000, <br />PREMISES Ea o=rrence <br />S 100,000 <br />MED EXP(Any one person) <br />$ 10 , 000 <br />PERSONAL B ADV INJURY <br />$1,000,000 <br />Eugene <br />I <br />Per Occurrence <br />GENERAL AGGREGATE <br />$2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER <br />POLICY X JECT LOC <br />PRODUCTS - COMPIOP ADD <br />s2,000 <br />$ <br />B <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />NON-OWNED AUTOS <br />BA053479592 <br />07 /06/10 <br />07/06 /n <br />COMBINED SINGLE LIMIT <br />accident) <br />$1,000,000 <br />X <br />BODIL (Per person) <br />BODIL NJ IW <br />$ <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTY DAMAGE <br />(Per accident) <br />$ <br />S <br />$ <br />B <br />UMBRELLA LIAR <br />EXCESS LIAR <br />X <br />OCCUR <br />CLAIMS-MAOE <br />US053479592 <br />07 /06/10 <br />07/06/11 <br />- <br />EACH OCCURRENCE <br />$2,000,000 <br />AGGREGATE <br />52,000,000 <br />DEDUCTIBLE <br />RETENTION $ 10,000 <br />$ <br />X <br />a <br />C <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETORIPARTNERIEXECUTIV <br />OFFICERIMEMBE <br />(Mandatory in NH) <br />1! es. descnbeunder <br />DESCRIPTION OF OPERATIONS be. <br />NIA <br />1 _T399T <br />06/03/10 <br />06/03/11 <br />X <br />TORY LIMITS ER <br />E L EACH ACCIDENT <br />$ 500 , OOO <br />E L. DISEASE -EA EMPLOYEE <br />$500,000 <br />E.1- DISEASE - POLICY LIMIT <br />$500 000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Anach ACORD 757, Additional Remarks Sehodule, it more space Is required) <br />The City of Eugene is named as an Additional Insured as required by contract <br />ct2On of the Named Insured per form CGB576 0505 attached. <br />as esp1 <br />Copy o Public � Bond is attached. <br />CERTIFICATE HOLDER CANCELLATION <br />ACORD 25 (2009109) <br />©1988 -2009 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />" - cso4a(Q <br />EUGEN11 <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 />City of <br />Eugene <br />Attn: <br />Jim Ulrich <br />AUTHORIZED REPRESENTATIVE <br />100 W <br />10th Ave, Suite 400 <br />Eugene <br />I <br />OR 97401 <br />Q <br />ACORD 25 (2009109) <br />©1988 -2009 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />" - cso4a(Q <br />