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KLUMp·2 OP 10: EA ACORD-CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDIYYYY) ~ 12122/15 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 '.OW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED JRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies} 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 360-748-0051 ~~~~~CT Emily E. Buss Virgil R. Lee & Son 360-748-3941 ri1g~o Extl:360-748-0051 I r~~ No): 360-748-3941 HUB International NW, LLC P.O. Box 1226 ~~DA~~SS: ebuss@lovstedworthington.com Chehalis, WA 98532 John 0 Thurston INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Mutual of Enumclaw 14761 INSURED Dynamic Collectors, Inc. INSURER B : 790 S. Market Blvd INSURERC: Chehalis, WA 98532 INSURERD: INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER' REVISION NUMBER: 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 TYPE OF INSURANCE I~~i'i I~~ I t~~M~i';W·() I t~~Tli6iJVv, UMITS LTR POLICY NUMBER GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 r--!::l~~~~':..!.u_ Kt:N I t:u A X COMMERCIAL GENERAL LIABILITY X X CPPOO1272703 12127115 12127116 PREMISES tEa occurrencel $ 300,000 I CLAIMS-MADE [K] OCCUR MED EXP (Anyone person) $ 10,000 ~ WA Stop Gap below PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 r-- GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS· COMP/OP AGG $ 2,000,000 ~ POLICY n ~fR;: n LOC $ -~UTOMOBILE LIABILITY ,-- ii:~~~~~~~t~INGLE LIMIT $ 1,000,000 A ~ ANY AUTO CPPOO1272703 12/27115 12/27116 BODILY INJURY (Per person) $ ALL OWNED ,--SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ -r--NON·OWNED rp~~~Zc~d~t?AMAGE X HIRED AUTOS ~ AUTOS $ - $ UMBRELLA LlAB .H OCCUR EACH OCCURRENCE $ -EXCESS L1AB CLAIMS-MADE AGGREGATE $ OED I I RETENTION $ $ WORKERS COMPENSATION I WC STATU· I X IOTH- AND EMPLOYERS' LIABILITY TORY LIMITS ER YIN A ANY PROPRIETORIPARTNERlEXECUTIVE 0 CPPOO1272703 12/27/15 12/27116 E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) WASTOPGAP E.L. DISEASE· EA EMPLOYEE $ 1,000,000 If yes, describe under E.L. DISEASE · POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Kittitas County is named as Additional Insured as required by written contract, as per CG 20 26 04/13. Waiver of Subrogation applies, as per CG 24 04 05/09 . Coverage is Primary and Non-Contributory, as per CG 20 01 04/13. CERTIFICATE HOLDER CANCELLATION KITTITA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WilL BE DELIVERED IN Kittitas County ACCORDANCE WITH THE POLICY PROVISIONS. 205 W. 5th Avenue Ellensburg, WA 98926 AUTHORIZED REPRESENTATIVE g.Drt-& . .:JRw..-1;;t; I © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD