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CERTIFICATE OF LIABILITY INSURANCE Issue Date 3/7/2016 ISSUED BY: THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY State of Washington AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS Department of Enterprise Services CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE Office of Risk Management AFFORDED BY THE STATE OF WASHINGTON SELF INSURANCE PO Box 41466 LIABILITY PROGRAM. Olympia WA 98504-1466 COVERAGE AFFORDED BY State of Washington Self Insurance Liability Program INSURED: THE STATE OF WASHINGTON, INCLUDING ALL ITS AGENCIES AND DEPARTMENTS, IS SELF-INSURED FOR TORT LIABILITY CLAIMS. ALL State of Washington CLAIMS MUST BE FILED WITH THE STATE OFFICE OF RISK Central Washington University MANAGEMENT FOR PROCESSING IN ACCORD WITH STATUTORY ATTN: Toni Burvee REQUIREMENTS. 400 East University Way Ellensburg, WA 98926-7474 COVERAGES THIS IS TO CERTIFY COVERAGE DESCRIBED BELOW IS PROVIDED TO THE INSURED NAMED ABOVE FOR THE PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE COVERAGE AFFORDED BY THE SELF-INSURANCE LIABILITY PROGRAM IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH PROGRAM. POLICY EFFECTIVE EXPIRATION TYPE OF COVERAGE NUMBER DATE DATE LIMITS GENERAL LIABILITY ® GENERAL LIABILITY Self-Insured Continuous Continuous BODILY INJURY, PROPERTY $5,000,000 DAMAGE & PERSONAL INJURY OCCURRENCE COVERAGE COMBINED EACH OCCURRENCE AUTOMOBILE LIABILITY ❑ ANY AUTO BODILY INJURY & PROPERTY $5,000,000 DAMAGE COMBINED EACH ALL OWNED AUTOS ACCIDENT ❑ SCHEDULED AUTOS ❑ HIRED AUTOS ❑ NON-OWNED AUTOS WORKERS COMPENSATION AND L & I Continuous Continuous WC - STATUTORY EMPLOYERS LIABILITY 52WEGE1229 6/30/15 6/30/16 EL - $1,000,000 -per AccldenU$1,000,000 Disease per Policy/$1,000,000 Disease per Employee OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS: Coverage applies as respects tort liability claims against the State of Washington as covered by the Tort Claims Act (RCW 4.92 et seq.) The Certificate Holder is named as additional insured, but only as respects the negligence of the State of Washington. CERTIFICATE HOLDER: CANCELLATION KITTITAS COUNTY SHOULD THE SELF INSURANCE LIABILITY PROGRAM BE CANCELLED, THE STATE OF WASHINGTON WILL ENDEAVOR TO MAIL 45 DAYS WRITTEN 205 WEST 5TH, SUITE 108 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE ELLENSBURG, WA 98926 TO MAIL SUCH NOTICE SHALL NOT IMPOSE ANY OBLIGATION OR LIABILITY UPON THE STATE OF WASHINGTON, ITS OFFICIALS, EMPLOYEES, AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE, CERTIFICATE NUMBER CRT 16-468 1 Lucy Isaki, State REsk Mann er