HomeMy WebLinkAboutInsurance Certificate: Mountain View Paving Inc (2)
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Oregon Workers' Compensation Sa, f
Certificate of Insurance
C0,000corporation
Certificate holder:
CITY OF ASHLAND
PURCHASING - ATTN SHERRIE
90 N MOUNTAIN AVE
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 this policy is subject to all the terms, exclusions and conditions of
such policy; this policy is subject to change or cancellation at any time.
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Insured Producer/contact
Mountain View Paving Inc Ward Insurance Agency Inc
PO Box 508 Chris Christensen
Talent, Or 97540-0508 541.687.1117 chris@wardinsurance.net
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Issued 09/26/2014 Limits of liability
Policy 496578 Bodily Injury by Accident $500,000 each accident
Period 10/01/2014 to 10/01/2015 Bodily Injury by Disease $500,000 each employee
Body Injury by Disease $500,000 policy limit
Description of operations/locations/special items
All operations performed by the named insured for the certificate holder in accordance with policy terms and
conditions.
Important
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
tl
John D. Gilkey
Interim President and CEO
400 High Street SE
Salem, OR 97312
P: 800.285.8525
F: 503.584.9812
Pol i cy_OLCA_CertificateOf Insuran ce