OREGON WORKERS' COMPENSATION <br />CERTIFICATE OF INSURANCE <br />CERTIFICATE HOLDER: <br />CITY OF EUGENE FACILITY MANAGEMENT <br />210 CHESHIRE AVE <br />EUGENE, OR 97401 <br />aif <br />corporation <br />The policy 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 />438282 10/01/2009 TO 10/01/2010 10/16/2009 <br />INSURED: BROKER OF RECORD: <br />JOHN HYLAND CONSTRUCTION INC WARD INSURANCE AGENCY INC <br />PO BOX 7867 PO BOX 10167 <br />EUGENE, OR 97401-0033 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 />Bodily Injury by Disease $500,000 policy limit <br />DESCRIPTION OF OPERATIONS/LOCATIONS/SPECIAL ITEMS: <br />Re: Lifeflight Helipad at Fire Stateion 2, Job No. 4656, Contract No. 2010-00009 <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 the future. <br />This 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 />CANCELLATION: <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL MAIL 30 DAYS, WRITTEN <br />NOTICE TO THE ABOVE NAMED CERTIFICATE HOLDER. <br />AUTHORIZED REPRESENTATIVE <br />3r g?c~' P RVCJAiP- <br />President and CEO <br />© SAIF CORPORATION 1 400 High St SE I Salem, OR 973121 P: 800.285.8525 1 www.saif.com <br />