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OREGON WORKERS COMPENSATION + SaiF
CERTIFICATE OF INSURANCE MAP
CERTIFICATE HOLDER:
CITY OF ASHLAND
PUBLIC WORKS / ENGINEERING DIVISION
20 EAST MAIN STREET
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
524494 10/01/2013 to 10/01/2014 10/01/2013
INSURED: BROKER OF RECORD:
BATZER CONSTRUCTION INC WARD INSURANCE AGENCY INC
PO BOX 4460 PO BOX 10167.
MEDFORD, OR 97501-0267 EUGENE, OR 97440
LIMITS OF LIABILITY:
Bodily Injury by Accident $500,000 each accident
Bodily Injury by Disease $500,000 each employee
Body Injury by Disease $500,000 policy limit
DESCRIPTION OF OPERATIONS/LOCATIONS/SPECIAL ITEMS:
Contractor Pre-Qualification
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.
AUTHORIZED REPRESENTATIVE
President and CEO
400 High Street SE
Salem, OR 97312
P: 800.285.8525
F: 503.373.8020
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