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CLEAHAR-01 SHELTONJE ACORDft CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY) ~ 3/24/2016 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(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 ~~~~~CT Willis Towers Watson Certificate Center Willis of Massachusetts, Inc. rlJgN~o Extl: (877) 945-7378 I r..e~ No): (888) 467-2378 clo 26 centu~ Blvd E·MAIL C rtT t '@1 ·11" P.O . Box 305 91 ADDRESS: e I Ica es WI Is.com Nashville, TN 37230-5191 INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: ACE American Insurance Company 22667 INSURED INSURER B : American Guarantee and Liability Insurance Company 26247 Thermo Fluids Inc. INSURER c : Indemnity Insurance Company of North America 43575 14624 N. Scottsdale Rd., Suite 300 INSURER 0: Scottsdale, AZ 85254 INSURERE: INSURERF : 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 VIIITH 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 ADDL ISUBR 1(~~Mg~) 1(~g76g~) LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 r--:J_ CLAIMS-MADE 0 OCCUR ~~~~~~~ YE~~~~~nce) X X HDOG2740067A 11/0112015 11/01/2016 $ 500,000 r-x XCU MED EXP (Anyone person) $ 5,000 r-x Contractual PERSONAL & ADV INJURY $ 2,000,000 r-- GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 R POLICY 0 ~r8T 0 LOC PRODUCTS -COM PlOP AGG $ 4,000,000 OTHER: $ AUTOMOBILE LIABILITY fE~~~~~~t~INGLE LIMIT $ 5,000,000 f-=-=- A X ANY AUTO X X ISAH08860889 11/01/2015 11/01/2016 BODILY INJURY (Per person) $ r-x ALL OWNED -SCHEDULED BODILY INJURY (Per aCCident) $ ~ AUTOS -AU TOS .!-HIRED AUTOS NON-OWNED rp~?~~C~d~~t?AMAGE $ -AU TOS X MCS-90 $ X UMBRELLA LlAB M OCCUR EACH OCCURRENCE $ 10,000,000 -B EXCESS LIAB CLAIMS-MADE AUC 4275262-11 11/01/2015 11/01/2016 AGGREGATE $ 10,000,000 OED I X I RETENTION $ 0 $ WORKERS COMPENSATION X I ~ffTUTE I IOTH- AND EMPLOYERS· LIABILITY ER C YIN X WLRC48592739 (AOS) 11/01/2015 11/01/2016 2,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE ~ E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L. DISEASE -EA EMPLOYEE $ 2,000,000 ~m:~f~irg~ O'~gPERATIONS below E.L. DISEASE -POLICY LIMIT $ 2,000,000 A Workers Compensation WLRC48592715 (AZ, CA, MA) 11/01/2015 11/01/2016 See Attached DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Kittitas County is named as an Additional Insured for General Liability and Auto Liability as their interests may appear if required by written contract but only with respect to liability arising out of operations of the Named Insured. It is understood and agreed that the company waives its right of subrogation which may arise by reason of a payment of claim under the General Liability, Auto Liability, Worker's Compensation policy(ies) as required by written contract where allowed by state law. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Kittitas County f1~ 925 S. Industrial Way IEliensburg, WA 98926 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD