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<br /> . ot~lr ~,vx ~vz a,ziQn 16/Z009 8 : 28 : p4 AM PAGE . 1/001 Fax Server <br /> OREGON WORKERS` COMPENSATIQN- - <br /> CERTIFICATE OF INSURANCE <br /> CERTIFICATE HOLDER: <br /> CITY OF EUGENE <br /> ATTN.: LINN <br /> 244 EAST BROADWAY <br /> EUGENE,- OR 97402 <br /> The poaicy of insurance listed below has been issued to the insured named below for the policy <br /> period indicated. The insurance afforded by the policy described herein is subject to all .the terms., <br /> exclusions and conditions of such policy. <br /> POLICY NO. POLICY PERIOD ISSUE' DATE <br /> 926889 03/O1j20Q9 TO 03/01/201q 06/16/20.09 <br /> INSURED: 6ROKER OF RECORD: <br /> SCOTT BROWN CONSTRUCTION INC <br /> PO 60X 7882 <br /> EUGENE, OR 97401 <br /> LIMITS OF LIABILITY: <br /> 6odiiy Injury by Accident $500,000 each accident <br /> Bodily Injury by Disease $500,000 each employee <br /> Bodily Injury by Disease $500,000 policy limit <br /> DESCRIPTION OF QPERATIONS/LOCATIONS/SPECIAL ITEM$i <br /> ALL OPERATIONS <br /> IMPORTANT: <br /> The coverage described above is in effect as of the issue date of this certificate. It is subject to <br /> .change at any time in th.e future. <br /> This certificate is issued as a matter of information only anal 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 /> CANCELLATION: <br /> SHOULD ANY OF THE ABOVE DESCRIBED PQLICIES BE CANCELED BEFORE THE EXPIRATION DATE <br /> THEREOF, THE ISSUING COMPANY WILL MAIL 30 DAYS' WRITTEN. NOTICE TO THE A60VE NAMED <br /> CERTLFICATE HOLDER. <br /> AUTHORIZER REPRESENTATIVE <br /> President and. CEO <br /> Cc~ SnIF CORPOR/1TION 1100 High St SE ~ Salmi, OR 87;12 ~ P: 800.285.8525 ~ www.saif.,com <br /> 06/16/2009 .TUE 03:27 [T,(rR;; PJO 5469] X001 <br /> <br />