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C,rtificate of Insurance Page 1 of 1 <br /> 4 <br /> OREGON WORKERS' COMPENSATION <br /> 400 High St SE CERTIFICATE OF INSURANCE <br /> alem, OR 97312-1000 <br /> o!! Free 1-800-255-8525 <br /> MAIL TO: CERTIFICATE HOLDER: <br /> CITY OF EUGENE CITY OF EUGENE <br /> FACILITY MANAGEMENT SERVICES FACILITY MANAGEMENT SERVICES <br /> '210 CHESHIRE AVENUE 210 CHESHIRE AVENUE <br /> :EUGENE, OR 97401 EUGENE, OR 97401 <br /> Th+e policy of insurance listed below has been issued to the insured named below for the policy period <br /> indicated. The insurance afforded by the policy described herein is subject to all the terms, exclusions <br /> and conditions of such policy. <br /> POLICY NO. POLICY PERIOD ISSUE DATE <br /> 810406 10/01/2003 TO 10/01/2004 09/24/2004 <br /> INSURED: BROKER OF RECORD: <br /> STATON COMPANIES WILLIS OF EUGENE <br /> PO BOX 7515 PO BOX 1357 <br /> EUGENE, OR 97401-0020 EUGENE, OR 97440 <br /> LIMITS OF LIABILITY: <br /> Bodily Injury by Accident $500,000 each accident <br /> Bodily Injury by Disease $500,000 each employee <br /> <br /> ~rin Bodily Injury by Disease $500,000 policy limit <br /> D@S~RIPTION OF OPERATIONS/LOCATIONS/SPECIAL ITEMS: <br /> Lindoln Yards Warehouse Demolition #2005-00017 <br /> INPCIRTANT: <br /> Tthe'' coverage described above is in effect as of the issue date of this certificate. It is subject to change at <br /> amy'time in the future. <br /> T~iS certificate is issued as a matter of information only and confers no rights to the certificate holder. <br /> This certificate does not amend, extend or alter the coverage afforded by the policies above. <br /> CANICELLATION: <br /> SHQULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE <br /> TH~REOF, THE ISSUING COMPANY WILL MAIL 30 DAYS' WRITTEN NOTICE TO THE ABOVE NAMED <br /> CERTIFICATE HOLDER. <br /> AUTHORIZED REPRESENTATIVE <br /> https://saifonline.saif.com/online/certs/certForm.aspx 9/24/2004 <br /> <br />