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979884 - WILDISH CONSTRUCTION CO - Certificate of Insurance <br />OREGON WORKERS' COMPENSATION <br />CERTIFICATE OF INSURANCE <br />MAIL TO: <br />CITY OF EUGENE <br />99 EAST BROADWAY, SUITE 400 <br />EUGENE, OR 97401 <br />Page 1 of 1 <br />a' <br />corporation <br />CERTIFICATE HOLDER: <br />CITY OF EUGENE <br />99 EAST BROADWAY, SUITE 400 <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 />979884 10/01/2009 TO 10/01/2010 03/12/2010 <br />INSURED: BROKER OF RECORD: <br />WILDISH CONSTRUCTION CO WARD INSURANCE AGENCY INC <br />PO BOX 7428 PO BOX 10167 <br />EUGENE, OR 97401 EUGENE, OR 97440 <br />LIMITS OF LIABILITY: <br />Bodily Injury by Accident $500,000each accident <br />Bodily Injury by Disease $500,000each employee <br />Bodily Injury by Disease $500,000policy limit <br />DESCRIPTION OF OPERATIONS/LOCATIONS/SPECIAL ITEMS: <br />11TH and 13th AVENUE PAVING. 11TH AVENUE FROM GARFIELD STREET TO TYINN STREET (JOB #4664). 13TH <br />AVENUE FROM ALDER STREET TO WASHINGTON STREET (JOB #4657). CONTRACT 2010-00015. <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 holder. This <br />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 EXPIRATION DATE THEREOF, <br />THE ISSUING COMPANY WILL MAIL 30 DAYS' WRITTEN NOTICE TO THE ABOVE NAMED CERTIFICATE HOLDER. <br />AUTHORIZED REPRESENTATIVE <br />President and CEO <br />© SAIF CORPORATION 1 400 High St SE I Salem, OR 97312 1 P: 800.285.8525 1 www.salf.com <br />https://saifonline.saif.com/Certificates/certFonn.aspx 3/12/2010 <br />