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www.saif.com <br />OREGON WORKERS COMPENSATION <br />CERTIFICATE OF INSURANCE <br />MAIL TO: <br />KIPCO INC <br />90465 WOODRUFF ST <br />EUGENE, OR 97402-9612 <br />CERTIFICATE HOLDER: <br />CITY OF EUGENE <br />858 PEARL STREET <br />EUGENE, OR 97401 <br />AMiP,saif <br />corporation <br />The policy of insurance listed below has been issued to the insured named below for the <br />policy period indicated. The insurance afforded by the policy described herein is subject to <br />all the terms, exclusions and conditions of such policy. <br />POLICY NO. POLICY PERIOD ISSUE DATE <br />521534 10/01/2009 to 10/01/2010 05/12/2010 <br />INSURED: <br />KIPCO INC <br />90465 WOODRUFF ST <br />EUGENE, OR 97402-9612 <br />BROKER OF RECORD: <br />LIMITS OF LIABILITY: <br />Bodily Injury by Accident $500,000 each accident <br />Bodily Injury by Disease $500,000 each employee <br />Body Injury by Disease $500,000 policy limit <br />DESCRIPTION OF OPERATIONS/LOCATIONS/SPECIAL ITEMS: <br />City of Eugene 2010 Stormwater Rehabilitation on 15th Avenue from Agate Street to Moss Street and <br />at the Intersection of 17th Avenue and Villard Street. <br />IMPORTANT: <br />The coverage described above is in effect as„of the issue date of this certificate. It is subject to change <br />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 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 />F~r <br />President and CEO <br />400 High Street SE <br />Salem, OR 97312 <br />P: 800.285.8525 <br />F: 503.373.8020 <br />Policy_Certiflcates_CertiflcateOfInsu ranee <br />