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$CHI IPnP.n4 <br />RAINIICII "r^K1 <br />CERTIFICATE OF LIABILITY INSURANCE <br />DA7EIMM/ppIYYYY) <br />POLICY L� Ji f" U LOC <br />OTHER: <br />1/216/2017 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE"- DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the palicy(Ios) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may raquire an endorsement. A statement on <br />this certificate does not confer eights to the certificate holder In lieu of such endorsement s . <br />PRODUCER <br />Cottage Grove Office <br />PayneWest Insurance, Inc. <br />CpNTACT <br />N-___-•--- --- ___ ___ _ __ <br />PHONE--`--"-`�"`- <br />tnrc, No, Ext : (541 942.0555 `ac, No):@41) 942.9860 - <br />E M <br />1646 East Main <br />R <br />Cottage Grove, OR 97424 <br />IN URER SAFFORDING COVERAGE MAIC # <br />INSURERA:SCOttsdale Insurance Com an <br />BODILY INJURY Per erson $ <br />—�- <br />INSURED <br />Richard Schuknocht dba Schukinecht's P.O.F Polygraph <br />INSURER B <br />Service <br />INSURER C: <br />INSURERD: <br />413 N 2nd"St6et <br />Yakima, EI�/ X8901 . <br />INSURER E <br />INSURER F: <br />Mr-M101VIY IYUIYIOCK; <br />THIS IS TO CERTIFY THAT THE POLICI12S Of= I4 RANCE- LISrTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY CZEQUII{EMENT TERIf QR:, CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY :PERTAIN, THS "INSURAWE, AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SIIGH f50CIC1E8 LIMITS"SHOWN N1AY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP <br />irunin POLICYNl' BER LIMITS <br />A )( COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE Is 1,000,000 <br />CLAIMS -MADE LAOCCUR RBS0006902 02/04/2017 02/04/2018 DR A@EE 0 a accurrDence} $ 100,000 <br />s_nnn <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Sahedule may 40.atto¢hec if more space Is required) <br />Certificate holder Is additional insured per attached form GLS487 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Kittitas County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />206 W 5th Ave, Ste 105 ACCORDANCE WITH THE POLICY PROVISIONS. <br />Ellensburg, WA 98926 <br />AUTHORIZED REPRESENTATIVE <br />\W*6_1� <br />Allno °f 9r lonacfnh, _. <br />w 7 VUU-ZU'I o AUUM0 CORPORATION. All rights reserved. <br />The ACORD name and logo are registREDra WA451 R) <br />a � <br />KI -Ful -AS COuwry SHERIFF <br />ACCOUNTING <br />POLICY L� Ji f" U LOC <br />OTHER: <br />PRODUCTS -COMPIOPAGO $ 2,000,000 <br />AUTOMOBILE <br />LI7ABILITY <br />ANY AUTO <br />0 ED SCHEDULED <br />AUTOS ONLY AUTOS <br />AiJRS ONLY AUTO ONLY <br />CE.NESINGLE LIMIT no $ <br />BODILY INJURY Per erson $ <br />—�- <br />JURYBRODILY IN Per accident)$ <br />PROaCEcldent MAGE $ <br />A <br />A <br />UMBRELLA LIAR <br />EXCESS LIAB <br />OCC <br />CLAiINS �AADE <br />"- <br />N / Jl <br />X <br />X <br />RBS00069O <br />RBS0006902 ;. <br />02/04/2017 <br />02/04/2017 <br />02/04/2018, <br />02704/2018 <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />DED RETENTION$ <br />WORK RS COMPENSATION <br />AND E PLOYERS' LIABILITY <br />ANY PR PRIETOR/PARTNER/EXECUTIVE Y/N <br />OFFICEIIppVM MB R DED? <br />(MandatorYJ NEXCLU <br />Ifyes describe under <br />DKOSt PTIO OF OPERATIONS below <br />Errors & Omissions <br />Errors &Omissions <br />$ <br />TH- <br />PR UTE" E <br />E L. EACH ACCIpENT ' . $ <br />E.L. DISEASE - E EMPLOYEE <br />E.L. DISEASE "FOLIC LIMIT <br />each claim "' 1,000,000 <br />aggregate 2,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Sahedule may 40.atto¢hec if more space Is required) <br />Certificate holder Is additional insured per attached form GLS487 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Kittitas County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />206 W 5th Ave, Ste 105 ACCORDANCE WITH THE POLICY PROVISIONS. <br />Ellensburg, WA 98926 <br />AUTHORIZED REPRESENTATIVE <br />\W*6_1� <br />Allno °f 9r lonacfnh, _. <br />w 7 VUU-ZU'I o AUUM0 CORPORATION. All rights reserved. <br />The ACORD name and logo are registREDra WA451 R) <br />a � <br />KI -Ful -AS COuwry SHERIFF <br />ACCOUNTING <br />