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CERTIFICATE OF LIABILITY INSURANCE <br />Issue Date 3/7/2016 <br />ISSUED BY: <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY <br />State of Washington <br />AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />Department of Enterprise Services <br />CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE <br />Office of Risk Management <br />AFFORDED BY THE STATE OF WASHINGTON SELF INSURANCE <br />PO Box 41466 <br />LIABILITY PROGRAM. <br />Olympia WA 98504-1466 <br />COVERAGE AFFORDED BY <br />State of Washington Self Insurance Liability Program <br />INSURED: <br />THE STATE OF WASHINGTON, INCLUDING ALL ITS AGENCIES AND <br />DEPARTMENTS, IS SELF-INSURED FOR TORT LIABILITY CLAIMS. ALL <br />State of Washington <br />CLAIMS MUST BE FILED WITH THE STATE OFFICE OF RISK <br />Central Washington University <br />MANAGEMENT FOR PROCESSING IN ACCORD WITH STATUTORY <br />ATTN: Toni Burvee <br />REQUIREMENTS. <br />400 East University Way <br />Ellensburg, WA 98926-7474 <br />COVERAGES <br />THIS IS TO CERTIFY COVERAGE DESCRIBED BELOW IS PROVIDED TO THE INSURED NAMED ABOVE FOR THE PERIOD INDICATED. <br />NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE COVERAGE AFFORDED BY THE SELF-INSURANCE LIABILITY PROGRAM IS SUBJECT <br />TO ALL THE TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH PROGRAM. <br />POLICY <br />EFFECTIVE <br />EXPIRATION <br />TYPE OF COVERAGE <br />NUMBER <br />DATE <br />DATE <br />LIMITS <br />GENERAL LIABILITY <br />Self -Insured <br />Continuous <br />Continuous <br />BODILY INJURY, PROPERTY $5,000,000 <br />® GENERAL LIABILITY <br />DAMAGE & PERSONAL INJURY <br />OCCURRENCE COVERAGE <br />COMBINED EACH OCCURRENCE <br />AUTOMOBILE LIABILITY <br />BODILY INJURY & PROPERTY $5,000,000 <br />❑ ANY AUTO <br />DAMAGE COMBINED EACH <br />® ALL OWNED AUTOS <br />ACCIDENT <br />❑ SCHEDULED AUTOS <br />❑ HIRED AUTOS <br />❑ NON -OWNED AUTOS <br />WORKERS COMPENSATION AND <br />& I <br />Continuous <br />Continuous <br />WC - STATUTORY <br />EMPLOYERS LIABILITY <br />6130115 <br />8130/16 <br />52WEGE1229 <br />EL - $1,000,000 —per Accident/$1,000,000 Disease <br />per Pollcyl$1,000,000 Disease per Employee <br />OTHER <br />DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESISPECIAL ITEMS: Coverage applies as respects tort liability claims against <br />the State of Washington as covered by the Tort Claims Act (RCW 4.92 et seq.) The Certificate Holder is named as <br />additional insured, but only as respects the negligence of the State of Washington. <br />CERTIFICATE HOLDER: CANCELLATION j <br />KITTITAS COUNTY SHOULD THE SELF INSURANCE LIABILITY PROGRAM BE CANCELLED, THE <br />STATE OF :". "MHWOTON WILL ENDEAVOR TO MAIL 45 DAYS WRITTEN <br />`: - - - ;ice.-.::. �iici) iv i tit LEFT, BUT FAILURE <br />_ OR LiABiuTY <br />E <br />y Is a ge <br />