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ACORD4!I CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYYI ~ 8/30/2016 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 pollcy(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 ~~ACT Donna Martinez Terril Lewis & Wilke Ins r~g~~O .Extl : (509)248-3515 [r~ Nol . (5091248-3673 POBox 1789 ~.rDA~ss:.dmartinez@tlwins. com 112 S 4th Street INSURER(SI AFFORDING COVERAGE NAICII Yakima WA 98907 INSURER A :Continental Insurance Company 35289 INSURED INSURERB :Continental Casualty Company 20443 Belsaas & Smith Construction, Inc . INSURER C :Travelers Property Casualty Co of 25674 POBox 926 INSURERD: INSURER E: Ellensburg WA 98926 INSURERF , COVERAGES CERTIFICATE NUM B ER·1.6-1 7 GAU IF 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 r'NSD I\wD 1 rr:~M%~, (~~~~ LIMITS LTR POUCY NUMBER X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 t--::=J CLAIMS-MADE W OCCUR ~~~~-~~~?~=eI'~el A t--$ 100,000 4032762755 9/1/2016 9/1/2017 MED EXP (Anyone person) $ 15,000 1- PERSONAL & ADV INJURY $ 1,000,000 I- GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 R pOLlcY 0~ D LOC PRODUCTS -COMP/OP AGG $ 2,000,000 OTH ER: $ AUTOMOBILE LIABILITY E=~~t~U'lf?LELIMfl $ 1,000,000 rx dent A ANY AUTO BODILY INJURY (Per person) $ t--ALL OWNED r--SCHEDULED AUTOS AUTOS 4032762738 9/1/2016 9/1/2017 BODILY INJURY (Per accident) $ l-t--NON-OWNED rp~~~~,?AMAGE HIRED AUTOS AUTOS $ l-t-- $ X UMBRELLA L1AB M OCCUR EACH OCCURRENCE $ 1 000 000 I- B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1 000 000 OED [ X I RETENTIOt-! $ 10 000 4032762741 9/1/2016 9/1/2017 $ WORKERS COMPENSATION J~~ur.E I I~H-AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE D N/A WA Stop Gap E.L. EACH ACCIDENT $ 1 ,000 ,000 OFFICER/MEMBER EXCLUDED? A (Mandatory In NH) 4032762755 9/1/2016 9/1/2017 E.L. DISEASE -EA EMPLOYE $ 1,000,000 ~~~~~rtir~~ 'g'$'ijPERATIONS below E.L DISEASE -POLICY UMIT $ 1. 000 000 C Installation Floater 6601189R157 9/1/2016 9/1/2017 Limit 100,000 Deductible 1,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule , may be attached If more space Is requ ired) Kittitas County, its successors and assigns, and the respective directors, officers, employees, agents and representatives of the County and its successors and assigns are named as additional insured, including completed operations, per forms CNA75079XX 0115 and CNA74705XX 0115. Coverage is primary per form CNA74705XX 0115 Waiver of Subrogation applies per form CNA74705XX 0115 _ Per project applies per form CNA74705XX 0115 CERTIFICATE HOLDER Kittitas County 2015 West 5th Avenue Suite 108 Ellensburg, ACORD 25 (2014/01) INS025 (?OI401) WA 98926 CANCE.LLATIO N 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 ~ennet h Frick/DONNA --if'~/~ © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD