New Search
03/16f'2005 15:58 5619531169 <br />E. ad Nation©I <br />QN. Council on <br />Compensation <br />Insurance, Inc. <br />EFFECTIVE DATE: 03/10/2005 <br />BINDER NUMBER: 36-20001-05075.543516 <br />FED ID NUMBER: 75-3139010 <br />APPLICATION ID: 14181080 <br />SERVICE CENTE <br />901 Peninsula Co ate Circle <br />Boca Raton, FL 33487 <br />TEL (800) 922-4123 <br />March 19, 2005 <br />CROCKETT INTERSTATE TOWING AND TRANSPORT INC <br />PO BOX 11341 <br />EUGENE, OR 97440 <br />RE: WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY BINDER <br />This is to acknowledge receipt of an initial or deposit premium payment and your application for <br />coverage through the Workers Compensation Insurance Plan for the State of ,OREGON. <br />Coverage Is provided under this binder, beginning at 12:01 A.M. on the effective date-shown above, <br />and with the Insurance company named below, and shall remain in effect until canceled or a policy <br />has been Issued. Coverage Is provided under the Workers Compensation Law of OREGON and of <br />such additional jurisdictions as may be requested, in accordance with the Plan rules. Employers <br />liability coverage is also provided, subject to the standard limits prescribed In the Basic Manual, <br />unless higher limits have been requested in accordance with the Plan rules: <br />Please retain this binder as evidence of the coverage until you receive your policy. <br />6-VY0 9R 1~~ <br />311e165 - Y10>6 <br />INSURANCE COMPANY: <br />S A I F CORPORATION <br />400 HIGH ST S E <br />SALEM, OR 97312-1000 <br />,5'q13-73 8u71 <br />AGE 1CY NAME: <br />REYIEWEp Oy <br />"'"t'OFEU~ r <br />J~W ' <br />TE <br />PAGE 01/02 <br />