HomeMy WebLinkAboutInsurance Certificate: Welburn Electric
saifcorporation
400 High Street SE
Salem, OR 97312-1000
Toll Free 1-800-285-8525
OREGON WORKERS COMPENSATION
CERTIFICATE OF INSURANCE
MAIL TO:
CERTIFICATE HOLDER:
CITY OF ASHLAND
20 E. MAIN STREET
ASHLAND, OR 97520
CITY OF ASHLAND
20 E. 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.
488390
INSURED:
WELBURN ELECTRIC INC
PO BOX 329
PHOENIX, OR 97535-0329
POLICY PERIOD ISSUE DATE
1 % 1/2008 to 1 % 1/2009 10/16/2008
BROKER OF RECORD:
LIMITS OF LIABILITY
Bodily Injury by Accident $500,000 each accident
Bodily Injury by Disease $500,000 each employee
Bodily Injury by Disease $500,000 policy limit
DESCRIPTION OF OPERA TIONS/LOCA TIONS/SPECIAL ITEMS:
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.
AUTHORIZED REPRESENTATIVE
PJr?~ Jf l<~iJ-
President and CEO
oei 2 0 2008
INSURED
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