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OREGON WORKERS COMPENSATION
CERTIFICATE OF INSURANCE
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CERTIFICATE HOLDER:
CITY OF ASHLAND
20 EAST 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
al! the terms, exclusions and conditions of such policy.
POLICY NO.
451097
POLICY PERIOD
10/01/2010 to 10/01/2011
ISSUE DATE
09/30/2010
INSURED:
KAS & ASSOCIATES INC
304 SHOLLY ST
MEDFORD, OR 97501-3153
BROKER OF RECORD:
LIMITS OF LIABILITY:
Bodily Injury by Accident
Bodily Injury by Disease
Body Injury by Disease
$500,000
$500,000
$500,000
each accident
each employee
policy limit
DESCRIPTION OF OPERATIONS/LOCATIONS/SPECIAL ITEMS:
~Jefferson Avenue Extension Project No. 2005-10
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?J>' Jr R.q4iJ--
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President and CEO
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400 High Street SE
SaLem, OR 97312
P: 800.285.8525
F: 503.373.8020
Policy _Batch_ CertJflcateOfInsurance