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OREGON WORKERS COMPENSATION r` sai F
CERTIFICATE OF INSURANCE corporation
CERTIFICATE HOLDER:
CITY OF ASHLAND
20 E MAIN ST
ASHLAND, OR 97520
The policy of insurance listed below has been issued to the insured named below for the
policy period indicated. The insurance afforded by the policy described herein is subject to
all the terms, exclusions and conditions of such policy.
POLICY NO. POLICY PERIOD ISSUE DATE
911273 10/01/2012 to 10/01/2013 10/15/2012
INSURED: BROKER OF RECORD:
NEATHAMER SURVEYING INC
PO BOX 1584
MEDFORD, OR 97501-0120
LIMITS OF LIABILITY:
Bodily Injury by Accident $1,000,000 each accident
Bodily Injury by Disease $1,000,000 each employee
Body Injury by Disease $1,000,000 policy limit
DESCRIPTION OF OPERATIONS/LOCATIONS/SPECIAL ITEMS:
All Operations
IMPORTANT:
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 future.
This certificate is issued as a matter of information only and confers no rights to the certificate holder.
This certificate does not amend, extend or alter the coverage afforded by the policies above. This
certificate does not constitute a contract between the issuing insurer, authorized representative or
producer and the certificate holder.
CANCELLATION:
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE
THEREOF, NOTICE WILL BE DELIVERED TO THE POLICYHOLDER AND CERTIFICATE HOLDER IN
ACCORDANCE WITH THE POLICY PROVISIONS AND OREGON LAW. SAIF WILL ENDEAVOR TO
PROVIDE WRITTEN NOTICE WITHIN 30 DAYS WHENEVER POSSIBLE.
AUTHORIZED REPRESENTATIVE
x6qC!Pr
President and CEO
FOCT E
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400 High Street SE
Salem,OR 97312
P:800.285.8525
F:503.373.8020
Pol Icy—Batch_CertlficateOflnsurance