SH17-010 NW ASSESSMENT SERVICE PSA (Dr Pilarc)-PSA - 2017 FINAL with proof of prof liab

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ACERTIFICATE OF LIABILITY INSURANCE FDA A3DDIYYYY) 03// 15/ 15/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT POLICY EFF (MMIDDIYYYY) NAME: Trust Risk Management Services, Inc PHONE AIC, No, Ext): 877.637.9700 Fax AIC, No): 877.251.5111 Trust Risk Management Services, Inc. 1791 PahCircle ys pere Chicago, IL 60674 EMAIL ADDRESS: lnfo@trustrms.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: ACE American Insurance Company 22667 INSURED INSURER B: Dr. Monica Pilarc 4500 9th Ave NE Ste 300 INSURER C: Seattle, WA 98105 INSURER D: INSURER E: DAMAGE TO RENTED $ PREMISES(Ea occurrence) INSURER F: 1;1)VkwRA14iFS CFRTIFICATF NIIMRFR- DCVICIAkI K111RADCD. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUB WVD POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLICY EXP (MM/DDIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS MADE OCCUR DAMAGE TO RENTED $ PREMISES(Ea occurrence) MED EXP (Anyone person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY � JECOT F__] LOC GENERAL AGGREGATE $ PRODUCTS—COMP/OP AGG $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per Person) $ ANY AUTO ALL OWNEDSCHEDULED AUTOS AUTOS BODILY INJURY Per accident $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER 0H- $ AND EMPLOYERS LIABILITY Y / N STATUTE ERT _ E.L.EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE NIA F_ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $ E.L. DISEASE •POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below A Psychologist's Professional Liability Retroactive Date 06/07/2002 Y 58022353445 06/07/2016 06/07/2017 Each Incident Annual $1,000,000 $3,000,000 Aacirannte DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additlonal Remarks Schedule, may be attached If more space Is required) %.cr[1lrn.r%lc n%JLJcrc -t A1V1..CLLAIIUN Additional Insured Klttitas County 205 W 5th Avenue Ste 108 Ellensburg, WA 98926 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THBE L `��' "_ I V E DELIIVERED EXPIRATION ACCORDANCE WITH THE POLICY PR VIISIONS. i s 3 1 3' 9 JAUTHORIZED REPRESENTATIVE KlrrrrAs courrrY si-iERir:r ��--•�--- AUUKU Z5 tZU14/UT) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD