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52I 534 - KIPCO INC -Certificate of Insurance <br />.ORECzON WORKERS' COMPENSATION <br />CERTIFICATE OF INSURANCE <br />MAIL TO: <br />CITY OF EUGENE <br />244 E BROADWAY <br />EUGENE, OR 97401 <br />Page 1 of 1 <br />~~ <br />sa <br />lcorporation <br />CERTIFICATE HOLDER: <br />CITY OF EUGENE <br />244 E BROADWAY <br />EUGENE, OR 97401 <br />The policy of insurance listed below has been issued to the insured named below for the policy period indicated. The <br />insurance afforded by the policy described herein is subject to all the terms, exclusions and conditions of such policy. <br />POLICY NO. POLICY PERIOD ISSUE DATE <br />521534 10/01/2007 TO 10/01/2008 08/27/2008 <br />INSURED: BROKER OF RECORD: <br />KIPCO INC <br />90465 WOODRUFF ST <br />EUGENE, OR 97402-9612 <br />LIMITS OF LIABILITY: <br />Bodily Injury by Accident $soo,oooeach accident <br />Bodily Injury by Disease $soo,oooeach employee <br />Bodily Injury by Disease $50o,ooopolicy limit <br />DESCRIPTION OF OPERATIONS/LOCATIONS/SPECIAL ITEMS: <br />ROBIN HOOD AVENUE STORM MODIFICATIONS JOB #4571-CONTRACT 2009-04 <br />IMPORTANT: <br />The coverage described above is in effect as of the issue date of this certificate. It is subject to change at any time in the <br />future. <br />This certificate is issued as a matter of information only and confers no rights to the certificate <br />holder. This certificate does not amend, extend or alter the coverage afforded by the policies <br />above <br />AUTHORIZED REPRESENTATIVE <br />President and CEO <br />© SAIF CORPORATION 1400 High St SE (Salem, OR 97312 I P: 800.285.8525 I www.saif.com <br />https:Usaifonline.sai£com/Certificates/certForm.aspx 8/27/2008 <br />