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OCT DE '9~ 11~21 A. G. SADOWSKI C0.
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<br />PADOUCEA
<br />ORMATlON ONLY AND
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<br />THIS CERTIFtCATE ISi1SSUED AS
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<br />?~ . G. S adowski Company BY THE
<br />THE c VERAGE AFFCRO D
<br />DOES NOT MENO, EXTENt3 op ALTER
<br />13 95 Liberty Street S. E. PottcfES BE~ow.
<br /> COMRANlESAFFORDING COVERAGE
<br />Salem, Or 97302 ,
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<br />(503) 36~-2711 _
<br />I COMPANY A
<br />FAX: 5Q3-362-2837 ~~E'~T~ North Pacific Insurancz Compan
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<br />enceJKelly Constructian, Inc. -_......
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<br />OR. REG. #63435 i
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<br />THlS IS l'O CERTiFY THAT THH POLiCiE3 OF iNSURaNCE LISTED BEIOW HAVE BEEN ISSUED TO THE INSURED NAMED R80YE FOR THE POUGY PERIOD
<br />NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDtTION OE ANY CONTRACT OR aTHEF DOCUMENT WITH RESPECT 70 WFlICH THIS
<br />INDICATED
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<br />CEATIFICaTE MAY 8E 1SSUE0 OA MAY PERTAIN, THE 1NSURaNCE AFFOROED BY THE POLIC{ES DESCRIBED HEREIN 1S SuSJECT TO AL~ fHE TEaM3,
<br />IXCLUS1oNS AND CONDlTIONS OF SuCN POIICIES. UMI7s SMOwN MAY HAVE B£EN REOUGFD BY'PAiD CLAIMS. _ __ _
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<br />L RI TMPE GP IMSURAIfCE i .^ POL1C7 NYMBlR POLIGY EPFECTIVE POtJC1f EXGIRATION
<br />^ OATE (MM100lYY) DAT! (~f00/YY) ~ LIAIlTB
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<br />EN I GEkcRAL AGGPEGATE ! 52 , O O O, O O O
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<br />DESCRIPTIOM OF OPERa'iIOMBlLOCATION8/VE~Ct~S/SPECUII IT.F.NS' ~
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<br />ERIFICATION OF INSUR.P.NCE I
<br />IFICATE. H~LDER IS ADDITIONAL INSURED PER ATTACH;ED C5809.
<br />SHOULD ANY OF TFtE ABOV£ OESCR~BED POLICIES 8E CANCEL~Ed BEFORE THE
<br />ARION COi7NTY "~Y exP~w>Tio~1 OATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR t~
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<br />~Q pAYS WAlTTEN NOTIGE 70 THE CERTIFI.CATE HOI.CER NiAMED TO THE
<br />TTN : ELYN LYON ~;;; MAIL
<br />OO HIGH S'PREET '°' LEFT, 8UT FAILURE TO MAIL SUCH NOTICE 6MA~~ IMP08E NO OBLIGATtON OR
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<br />ALEM , OR 9 73 02 1 ~IABILITY OP ANY KINO UPON THE COMPANY. ITS AG~NTS OR FEPAEBENTA71vE3.
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