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ACORD~ CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDIYYYY) ~. 03/23/2016 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 CONTACT NAME: Trust Risk Management Services, Inc Trust Risk Management Services, Inc. PHONE I FAX (AlC, No. Ext): 877.637 .9700 (AlC , No): 877 .251 .5111 1791 Paysphere Circle EMAIL Chicago, IL 60674 ADDRESS: info@trustrms.com INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: ACE American Insurance Company 22667 INSURED INSURER B: Dr. Monica Pilarc INSURER C: 4500 9th Ave NE Ste 300 INSURER D: Seattle, WA 98105 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER REVISION NUMBER' TH IS 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 COND IT ION 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 ADDL SUB~ POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DDIYYYY) (MMIDDIYYYY) LIMITS COMMERCIAL GENERAL LIAB ILITY EACH OCCURRENCE $ -J CLAIMS MADE DOCCUR DAMAGE TO RENTED $ -PREMISES (Ea occurrence) MED EXP (Any one person) $ I-- PERSONAL & ADV INJURY $ ~'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ DPRO-D PRODUCTS-COMP/OP AGG $ r--POLICY JECT LOC OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident) I-- ANY AUTO BODILY INJURY (Per Person ) $ I--ALL OWN ED ;--SCHEDULED $ AUTOS AUTOS BODILY INJURY (Per accident I---NON-OWNED $ HIRED AUTOS PROPERTY DAMAGE AUTOS Per accident) --$ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ -- EXCESS L1AB CLAIMS-MAD E AGGREGAT E $ OED I I RETENTION $ $ WORKERS COMPENSATION IPER I DTH-$ AND EMPLOYERS LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE D N/A E.L.EACH ACCID ENT $ OFFICER/MEMBER EXCLUDED? E.L. DISEASE-EA EMPLOYEE $ (Mandatory in NH) $ If yes, describe under E.L. DISEASE -POLICY LIMIT DESCRIPTION OF OPERATIONS below Psychologist's Professional Liability Y 58G22353445 06/07/2015 06/07/2016 Each Incident $1,000,000 A Retroactive Date 06/07/2002 Annual $3,000,000 Aggregate DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION Additional Insured SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Kittitas County BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE 205 W 5th Avenue Ste 108 DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Ellensburg, WA 98926 AUTHOR IZED REPRESENTATIVE ~B ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD