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SAIF Corporation 3/22/2010 11:15:30 AM PAGE 1/001 Fax Server <br />OREGON WORKERS' COMPENSATION <br />CERTIFICATE OF INSURANCE[ <br />CERTIFICATE HOLDER: <br />CITY OF EUGENE <br />ENGINEERING DIV., PUBLIC WORKS DEPT. <br />99 E BROADWAY STE. 400 <br />EUGENE, OR 97401 <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 />627971 11/01/2009 TO 11/01/2010 03/2212010 <br />INSURED: BROKER OF RECORD: <br />ELMS LANDSCAPE SERVICES INC <br />28780 JAGER LN <br />JUNCTION CITY, OR 97448-9316 <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/ LOCATIONSISPECIALITEMS: <br />RE: ALTON BAKER PARK <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 <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 POLICIES BE CANCELED BEFORE THE EXPIRATION DATE <br />THEREOF, THE ISSUING COMPANY WILL MAIL 30 DAYS' WRITTEN NOTICE TO THE ABOVE NAMED <br />CERTIFICATE HOLDER. <br />AUTHORIZED REPRESENTATIVE <br />J <br />President and CEO <br />0 SAIF CORPORATION 1 400 High St SE' 1 Salem, OR 97312 1 P: 800.285.8525 1 www.self.com <br />03/22/2010 MON 10 15 [Tip/RY NO 58561 1a001 <br />