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CERTIFICATE OF LIABILITY INSURANCE Issue Date 11.1112018 <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 E University Way <br />Ellensburg, WA 98926 <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 />` <br />TYPE OF COVERAGE <br />NUMBER <br />DATE <br />DATE <br />I 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 />L & I <br />Continuous <br />Continuous <br />WC — STATUTORY <br />EMPLOYERS LIABILITY <br />52WEGE1229 <br />6/30/17 <br />6/30/18 <br />EL - $1,000,000 — per Accl dent/$ 1,000, 000 Disease <br />per Policy/$1,000,000 Disease per Employee <br />OTHER <br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL 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: <br />CANCELLATION <br />SHOULD THE SELF INSURANCE LIABILITY PROGRAM BE CANCELLED, THE <br />KITTITAS COUNTY <br />205 WEST 5TH, SUITE 108 <br />STATE OF WASHINGTON WILL ENDEAVOR TO MAIL Al DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE 11 <br />ELLENSBURG, WA 98926 <br />TO MAIL SUCH NOTICE SHALL NOT IMPOSE ANY OBLIGATION OR LIABILITY <br />UPON THE STATE OF WASHINGTON, ITS OFFICIALS, EMPLOYEES, AGENTS <br />ORRFzMESENTATIVES. <br />AU RIZ£D REPRESS I E: <br />CERTIFICATE NUMBER CRT 18-406 <br />J S9m__s; <br />� state F2isk AA <br />