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SCHUPOF-01 MMELTON <br />CERTIFICATE OF LIABILITY INSURANCE I DAlE (MMJDDIYYYY) <br />1/26/2017 <br />THIS CERTIFICATE IS ISSUED AS A MAnER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGAnVEL Y 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(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, s ubject to the terms and conditions of the policy, cert~l.n pDlicle9 may r~qulre an endot3&rr-.er.t. A statem~nt or. <br />this certificate does not confer rtgltts to the certificate holder In lieu of s uch ond orsomenl(si. <br />PRODUCER ~~CT CottageG~v.omce ~~E~-------------------------~I M~X~----.--\---------I <br />PaynliWest Insurance, Inc. HI WC:tii';l:r.'t{!!!.o.~Ext~)::..!(l.:.64..:.1~)~94=2~-O:.::56~5=--____ --,ull,oa=<.'!N~'!1:I:::.!:(64::::...:1L=:.194::.:2=--9=:8:.::6::0~_1 <br />1645 East Main 1~1k't.-Cottage G~ve, OR 97424 1~'--Fa;t'-----IN-SU--RE--Rf!S-IAF-FORDt--N-G-COVERA-----GE---------'r--JIAlC---.---1 <br />INSURED <br />Richard Schuknecht dba. Schuknecht's P.O.F Polygraph <br />Service <br />413 N 2nd Street <br />Yakima, WA 98901 <br />INSURER A : Scottsdale Insurance Comoanv <br />INSURERB : <br />INSURERC: <br />INSURERD: <br />INSURERE: <br />INSURERF : <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO II'JHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN . THE INSURA~~~.~FORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. <br />EXCI "~In.I~ AND CONDITIONS OF SUCH POLl ~ LIMITS SHOWN MI\' HAVE BEEN REDUCED BY PAID CLAIMS. <br />I '~M TYPEOF'''~'~ .~ '~t.'ftl/.U POUCYNUMBER POUCYEFF ,POiIctTxif UMITS <br />A X GENERAL UABIUTY I EACH IV'r •.. ",,,..,..,, S ;==p CLAIMS-MADE [K] OCCUR X 0210412017 0210412018 1 ~~19~~TEE. s <br />1_ I MED EXP (MV nnA """"",' $ <br />r----------------------r.'''''''-M-UMIT APPliES PER: ~'::: L.J ~r8r 0 lOC <br />-SCHEDULED <br />_ AUTOS <br />r-I>JNAUTO <br />OWNED 1_ AUTOS ONLY <br />1_ ~IWWSONlY _~m.1} <br />I-UMBREllA UAB H OCCUR <br />EXCESS UAB (':, " ... , "An, <br />OED I 1 I<t:.t:l'llIuN$ <br />WORKERS COMPENSA110N <br />AND EMPLOYERS' UABIUTY 0' <br />ANY PROPRIETORIPARTNER1EXECUTIVE N , A <br />~f~~~~m EXCLUDED? <br />1 !!X~~.!!~~ '8'tC5t ' , hAInw <br />A IErrors & X <br />A IErrors & Omissions X <br />per ati!lchl!d <br />CERTI FICATE HOLDER <br />1 C"DC!I'V.J It. Anv 1M.III~Y S <br />1 "'''''''''4' s <br />PRODUCTS <br />,UMIT <br />S <br />BODilY INJU~Y S <br />BODilY INJURY .-S <br />~j~lJu~MAGe S <br />S <br />I EACH "",.., 'CDC''''''' S , <br />S <br />E.L EACH ACCIDENT $ <br />F I n'l'lFAl'lF. FA "UD. nvc, II <br />E.l DISEASE. POLICY LIMIT I s <br />v~..-.. v. v .......... vI8 Ieach claim <br />0210412017 0210412018 _ .... ~ ... <br />• Aildilional Remarks Schedule, ma., be _chH If more space Is requl""') <br />GJ.S..487 <br />CANCELLATION <br />1,000,000 <br />100,000 <br />5,000 <br />~O'OCJO <br />? non IVIII <br />., nnr, nnn <br />1 nnn nnl1 <br />2,nnnnnt <br />SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE <br />Kittitas County <br />205 W 5th Ave, Ste 105 <br />Ellensburg, WA 98926 <br />J <br />ACORD 25 (2016103) <br />THE EXPlRA110N DATE THEREOF, N011CE WILL BE DELIVERED IN <br />ACCORDANCE WITH lHE POUCY PROVISIONS. <br />AUTHORIZED REPRESENTA 11VE <br />~~~"'- <br />@1988-2015ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are regist .. ,,.. ... f2~f.,.~A fO <br />KI rTlTAS U).')IIU ~;HEf::IFF <br />A.e COlJllTlt'IG