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OREGON WORKERS COMPENSATION + saiF
CERTIFICATE OF INSURANCE ,corporation
CERTIFICATE HOLDER:
CITY OF ASHLAND
20 E 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
all the terms, exclusions and conditions of such policy.
POLICY NO. POLICY PERIOD ISSUE DATE
911273 10/01/2011 to 10/01/2012 10/03/2011
INSURED: BROKER OF RECORD:
NEATHAMER SURVEYING INC
PO BOX 1584
MEDFORD, OR 97501-0120
LIMITS OF LIABILITY:
Bodily Injury by Accident $1',000,000 each accident
Bodily Injury by Disease $1,000,000 each employee
Body Injury by Disease $1,000,000 policy limit
DESCRIPTION OF OPERATIONS/LOCATIONS/SPECIAL ITEMS:
All Operations
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.
CANCELLATION:
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL MAIL 30 DAYS, WRITTEN
NOTICE TO THE ABOVE NAMED CERTIFICATE HOLDER.
AUTHORIZED REPRESENTATIVE
br67 . lP Rxoi►-�
President and CEO D 0 v
OCT 1, 0 2011
' 400 High Street SE
Salem,OR 97312
P:800.285.8525
F:503.373.8020
Pol Icy_Batch_CertificateOfinsura nce