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~RU' CERTIFICATE OF LIABILITY INSURANCE I DATE(MM/DD/yyyy) 03/15/2017 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(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 Manl!.gement Services. Inc Trust Risk Management Services, Inc. PHONE I FAX (AiC. No. Ext): 877.637.9700 (AiC. No): 877.251.5111 1791 Paysphere Circle EMAIL Chicago, IL 60674 ADDRE$!LinfoCOltrustrms.com INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: ACE American Insurance Company 22667 INSURED INSllRE~: Dr. Monica Pilarc INSURERC: 4500 9th Ave NE Ste 300 INSURER 0: Seattle, WA 98105 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. ~~R ADD L ~~ POUC YEFF POLlCYEXP TYPE OF INSURANCE INSR POLICY NUMBER (MMIDD/yyyY) (MMIDD/yyyy) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ I- tJ CLAIMS MADE D OCCUR DAMAGE TO RENTED $ I-PREMISES (Ea occurrence) MED EXP (Anyone person) $ I-$ PERSONAL & ADV INJURY ~N'l AGGREGATE LIMIT APPLIES PER: GENERALAGGRE.GA.Te. $ D PRO-D PRODUCTS-COMPfOP AGG $ I-POLICY JECT . lOC OT HERl AUTOMOBILE LIABiliTY COMBINED SINGLE LIMIT $ l-I (Ea accident) (IN,Y AUTO BODilY INJURY (Per Person) $ I-ALL OWNED -SCHEDULED $ f\lTToS AUTOS BODilY INJURY (Per acciden l I--NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS I (Per acciden O 1-: -$ UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ I-$ EXCESS L1AB CLAIMS-MADE AGGREGATE OED I I RETENTION $ $- WORKERS COMPENSATION I ;ER I OTH. $ AND EMPLOYERS LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE 0 NfA E.LEACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? EL D.LSEASE·EAEMPLQV EE $ (Mandatory In NH) $ If yes, describe under E.L. DISEASE· POLICY LIMIT D.ES CRIPTION OF OP ERATI ONS below Psychologist's Professional Liability Y 58G22353445 06/07/2016 06/07/2017 Each Incident $1,000,000 A Retroactive O<lte 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) CERTIFI CATE H OLPER CANCELLATION Additional Insured SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Kittitas County RECEIVED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE 205 W 5th Avenue Ste 108 DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Ellensburg, WA 98926 , ~~." AUTHORIZED REPRESENTATIVE .: ~B KITTITAS COUI'JTY SHERIFF /\r("'l'\' l ~J T .. ~.'""" ... I n I , ACORD 25 (2014/01) © 1988-2014ACORD CORPORATION. All rrghts reserved. The ACORD name and logo are registered marks of ACORD