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~ FJW ACC>R O " CERTIFICATE OF LIABILITY INSURANCE I DATE (Mrv~DD/YYYY) '---'" ROOl 1/23/2018 THIS CERTIFICATEIS 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 have ADDITIONAL INSURED provisions or 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(sf PRODUCER =ACT MICHELETTI INSURANCE SERVICES/PHS -"II""'", (866) 467-8730 I ~, No) (888) 443-6112 (AlC, No, ExL): 556314 P: (866) 467-8730 F: (888) 443-6112 E·MAIL ADDRESS: PO BOX 33015 INSURER(S) AFFORDING COVERAGE NAIC# SAN ANTONIO TX 78265 INSURER A: Sentinel Ins Co LTD 11000 INSURED INSURER B ~ , LAW ENFORCEMENT PSYCHOLOGICAL INSURER C SERVICES, INC. INSURER D: 15251 NATIONAL AVE STE 201 INSURERE : LOS GATOS CA 95032 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. INSR TYPE OF INSURANCE ~.~~; SUBR POLICY NUMBER PUUC YEFF POUCYEXP LIMITS .'LTR wI'n IM"PlIWYYYY.I , tnnlVYV' COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE ~2, 000,000 I CLAIMS-MADE 0 OCCUR DAMAGE TO RENTED d , 000, 000 PI'lEIAIS EStE:. o tlCl """'~.l A X General Liab 57 SBA BZ5288 04/01/2017 04/01/2018 MED EXP (Anyone person) d O,OOO - PERSONAL & ADV INJURY ,2, 000, 000 -~41 000, 000 ~~'L ~ GGj EGAT j LIMIT APPLIES PER: GENERAL AGGREGATE PRo-0 PRODUCTS· COMPIOP AGG ~4, 000, 000 POLICY JECT LOC OTHER: , AUTOMOBILE LIABILITY COI.mINED sU~ll!.e liMIT 12,000,000 lE~ 3OI1Ii!onll I ~ ANY AUTO BODILY INJURY (Per person) 3 ~ OWNED r---SCHEDULED A 57 SBA BZ5288 04/01/2017 04/01/2018 BODILY INJURY (Per accidenl) :, ~ AUTOS ONLY ~ AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE ~" AUTOS ONLY AUTOS ONLY I (Per accident) ~ ~ ~ X UMBRELLA LlAB M ,OCCUR EACH OCCURRENCE $1,000,000 A r-- ' CLAIMS-MADE ,1,000,000 EXCESS LlAB 57 SBA BZ5288 04/01/2017 04/01/2018 AGGREGATE c.ml X l"E r .i'fI '~" 1 0, 000 ~ WORKERS COMPENSATION I PER I I ~~' AND EMPl.OYERS' 1.IAHIUTY STATUTE ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E L EACH ACCIDENT g OFFICER/MEMBER EXCLUDED? D NIA ~ " (Mandatory in NH) E L DISEASE· EA EMPLOYEE ~ If yes, describe under E L DISEASE· POLICY LIMIT I; DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. Certificate holder is an additional insured per the Business Liability Coverage Form SSOO08 attached to this policy. 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, Kittitas County AUTHORIZED REPRESENTATIVE 205 W 5TH AVE STE 108 6~o(C~~ ELLENSBURG, WA 98926 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD