PO 2011100413 Rexius Ins 8-19-11

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REXI01C OP ID: LD '4CORi CERTIFICATE OF LIABILITY INSURANCE DATE(M19DIYYYY) 08/19/11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 541 - 741 -0550 CONTACT NAME: KPD Insurance, Inc. PO PO Box 784 541- 741- 16741A Springfield, OR 97477 John S. Melvin, CIC o Ext: FAX E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # EACH OCCURRENCE INSURER A: American States Insurance Co DAMAGE TO RENTED PREMISES Ea occurrence $ 200 000 INSURED Rexius Forest By- Products, Inc PO Box 22838 INSURER B: PERSONAL & ADV INJURY $ 1,000,000 Eugene, OR 97402 INSURER C $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY X PRO- n LOC JECT PRODUCTS - COMP /OP AGG $ 2,000,000 INSURER D: $ INSURER E: AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED X SCHEDULED AUTOS AUTOS X HIRED AUTOS X NON -OWNED AUTOS INSURER F 01 CH1844366 08/23/11 COVERAGES CERTIFICATE NUMBER: REVISION. NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE DDL INSR UBR WVD POLICY NUMBER POLICY EFF MM /DD/YYYY POLICY EXP MM /DD/YYYY LIMITS • GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR X Contractual 01 CH1535146 08/23/11 08/23/12 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 200 000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY X PRO- n LOC JECT PRODUCTS - COMP /OP AGG $ 2,000,000 $ • AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED X SCHEDULED AUTOS AUTOS X HIRED AUTOS X NON -OWNED AUTOS 01 CH1844366 08/23/11 08/23112 COMBINED SINGLE LIMIT Ea accident $ 1 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ • UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 01SU3846326 08/23/11 08/23/12 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ DED I X I RETENTION $ 10,000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) Ifyes, describe under UESCRIPTION OF OPERA i IONS below N/A STATU- OTH- TOR Y LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E L OISEASE - POLICY 13,11T 1 $ A Installation Cov. All Risk 01CH1535146 08/23/11 08/23/12 Limit 250,000 Ded 1,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: All Operations L,rK I II I t r1ULUtK I,AIVL.tLLA I IUIV CITEU04 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Eugene THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN y g ene ACCORDANCE WITH THE POLICY PROVISIONS. Public Works Dept. 1820 Roosevelt Blvd Eugene, OR 97402 AUTHORIZED REPRESENTATIVE i � y� © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD