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.~A::~~:.:.'~.AIF i~t=~F'F't_~F:'t.TI~:_iPd - U=~:'16:•'01 Cc3;06:48 F'I~•I F'aciY 1 <br />S~: J,`~::~;~;~r.~l.;:~~'~,fF~~N <br />400 High St SE <br />Salem, OR 97312-1000 <br />Toll Free 1-800-285-8525 <br />CERTIFICATE HOLDER: <br />MARION COUNTY <br />ATTN; CATHY <br />P.O. BOX 14500 <br />SALEM, OR 97309 <br />OREGON WORKERS' COMPENSATION <br />CERTIFICATE .OF INSURANCE <br />The policy of insurance listed below has been issued to the insured named below for <br />the policy period indicated. The insurance afForded by the policy described herein is ' <br />subject to all the terms, exclusions and conditions of such policy. ', <br />POLICY NO. POLICY PERIOD ISSUE DATE <br />490276 O1/O1/2001 TO O1/O1/2002 03/16/2001 <br />INSURED: BROKER OF RECORD: <br />INTERFACE ENGINEERING INC HEFFERNAN INSURANCE BROKERS <br />6542 SE LAKE ROAD PO BOX 368 <br />MILWAUKIE, OR 97222-2138 PORTLAND, OR 97207-0368 <br />LIMITS OF LIABILITY: <br />Bodily Injury by Accident $1,000,000 each accident <br />Bodily Injury by Disease $1,000,000 each employee <br />Bodily Injury by Disease $1,000,000 policy limit <br />DESCRIPTION OF OPERATIONS/LOCATIONS/SPECIAL ITEMS: <br />PROJECT; COURTHOUSE SQUARE TESTING AND BALANCING PROJECT# 2000-0428 <br />IMPORTANT: <br />The coverage described above is in effect as of the issue date of this certificate. It is <br />subject to change at any time in the future. <br />This certificate is issued as a matter of information only and confers no rights to the <br />certificate holder. This certificate does not amend, extend or alter the coverage <br />afforded by the policies above. <br />AUTHORIZED REPRESENTATIVE <br />~~ - <br />~ <br />._..-N . ~' ~~~` <br />