HomeMy WebLinkAboutInsurance Certificate: City of Ashland Workers Comp
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Oregon Workers' Compensation
Certificate of Insurance Ore
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C?regtin.
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 belowfor 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.
Insured Producer/contact
Mountain View Paving Inc Ward Insurance Agency Inc
PO Box 508 Mike Godfrey
Talent, Or 97540-0508 541.687.1117 mike@wardinsurance.net
I
Issued 09/21/2018 Limits of liability
Policy 496578 Bodily Injury by Accident $500,000 each accident
Period 10/01/2018 to 10/01/2019 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
r
Kerry Barnett
President and CEO
400 High Street SE
Salem, OR 97312
P: 800.285.8525
F: 503.584.9812
PolIcy_OLCA_cert IM c ate ON ns uran ce