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KPD Insurance, Inc. <br />Nov. 15 -2010 10:00:47 Pg. 002 <br />ACORD CERTIFICATE OF LIABILITY INSURANCE O LI° G <br />DA Zi� D rs o <br />w <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />PRODUCER <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />TYPE OF INSURANCE <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />KPD Insurance, Inc. <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />PO Box 784 <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Springfield OR 97477 <br />GENERAL LIABILITY <br />Phone: 541- 741 -0550 Fax:541- 741 -1674 <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURED <br />INSURERA Oregon Employers Trust <br />COMMERCIAL GENERAL LIABILITY <br />INSURER (Self- Insured Group) <br />Roger Langeliers Construction <br />32929 Roberts Court <br />Coburg OR 97408 <br />INa-RERC New York Marine 6 General <br />$ <br />INSURER (Excess Insurance Company) <br />INSURER c/o Empire Pacific Risk <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />LTR <br />INSRE <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />PATE MM /OGM <br />OATE MM /DOM <br />LIMBS <br />REPRESENTATIVES <br />AUT IZEDjREPRES ATI <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ <br />COMMERCIAL GENERAL LIABILITY <br />FFEMISES (Ea e. curarcal <br />$ <br />CLAIM; MADE OCCUR <br />MED EXP (Any one Pe son) <br />$ <br />PEPSONAL & ADV INJURY <br />$ <br />GENERAL AGGREGATE <br />$ <br />GENLAQGREGATELIMITAPPLIEGPER <br />FRODUCTS - COMP )OP AGO <br />$ <br />FOLK -Y PRO- <br />JECT LGC <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />COMBINED DINGLE LIMIT' <br />IEa aeadanq <br />$ <br />BODILY INJ..Ft <br />IDar Far =on <br />$ <br />ALL OWNED AUTOS <br />scNEDULED ALlros <br />BODILY <br />[Per ar danq <br />ade,I) <br />HIRED A1Trns <br />NON- G✓\INED Al TO; <br />PROPERTY DAMAGE <br />IPere cidi <br />$ <br />._ ,.,4;./.? <br />. <br />,.. f.,'�k r'= <br />b$y t <br />GARAGE LWBILRY <br />AUTO ONLY - EA ACCIDENT <br />¢ <br />OTHER THAN EA ACC <br />$ <br />ANY AULLO <br />$ <br />AUTO ONLY AGG <br />EXCESS/UMBRELLA LIABILRY <br />OCCUR__M14`.4s CLAIM2 MADE <br />• -" "` ^ " <br />?y y,' j�`Yy; <br />' - H'.T <br />EACH OCCURRENCE <br />AGGREGATE <br />¢ <br />g <br />DEDUCTIBLE <br />¢ <br />RETENTION ¢ <br />WORKERS COMPENSATION AND <br />X TOP, LIMIT: X ER <br />.T. <br />EMPLOYERS'LIA <br />AN/ FFOPRIEWF /PAFTNi L ITIVE <br />088 WC10 0119 <br />10/01/10 <br />10/01/11 <br />EL EACH ArCICENT <br />¢2,000,000 <br />EL DISEASE- EA ENFLOYEE¢2,000,000 <br />C <br />OIFICER/MEMBER EXCLU_ <br />MW 100231 <br />If yes, de cube under <br />SPEC N. PROVISIONS �ebw <br />E L DISEA�.E- POLICY LIMIT <br />s2,000,000 <br />OTHER <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />RE: Ferry Street Bridge Corridor Joint Repairs (Contract #2011- 00476) <br />CERTIFICATE HOLDER CANCELLATION <br />CITEU04 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />City of Eugene <br />1820 Roosevelt Blvd <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, BS AGENTS OR <br />Eugene OR 97402 <br />REPRESENTATIVES <br />AUT IZEDjREPRES ATI <br />ACORD 25 (2001108) 1 ` ' (DD ACORD CORPORATION 1988 <br />