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-~ FJW A CtC>RC>" I DATE (MMlDDIYYYY) 10..----CERTIFICATE OF LIABILITY INSURANCE ROO1 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(sl. p""uur:~f< ~.:"cr MICHELETTI INSURANCE SERVICES/PHS P>I ~"6 (AlC, No, ExL): (866) 467-8730 K~. No) (8 8 8 ) 443-6112 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 INSURER E 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 . fNSR TYPE OF INSURANCE A "D~ SIION POLICY NUMBER POLICYEFF POLlCYEXP LIMITS ,TN INSN -"'VD (JrIM/DDIYY:m COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE ,2,000,000 I CLAIMS-MADE ~ OCCUR DAMAGE TO RENTED ,1,000,000 PREMISES LEa occurrence) A X General Liab 57 SBA BZ5288 04/01/2018 04/01/2019 MED EXP (Anyone person) -10,000 -PERSONAL & ADV INJURY ;2,000,000 c--- ~N'L IIGGREGAT E LIMIT APPL IES PER: GENERAL AGGREGATE ;4,000,000 DPRO-0 PRODUCTS -COMP/OP AGG .4,000,000 POLICY JECT' LOC OTHER: ; AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ;2,000,000 l Ea accident ) - ANY AUTO BODILY INJURY (Per person) , -OWNED ~ SCHEDULED A AUTOS ONLY AUTOS 57 SBA BZ5288 04/01/2018 04/01/2019 BODILY INJURY (Per accident) l' ~ l- X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) , ~ l- S X UMBRELLA LlAB M OCCUR EACH OCCURRENCE d,OOO,OOO A ~ EXCESS LIAB CLAIMS-MADE 57 SBA BZ5288 04/01/2018 04/01/2019 AGGREGATE d,OOO,OOO _I X l ~f,r""II;I" I 10 , 0 0 0 , WORKERS COMPENSAT{QN ~TUTE II~ AND E.1!Pl.OYERS' LfABll.ITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E L EACH ACCIDENT , OFFICER/MEMBER EXCLUDED? D NIA l-f (Mandatory in NH) E L DISEASE-EA EMPLOYEE '- If yes, describe under E.L DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERA nONS I LOCATIONS I 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. CERTIF ICAT E HOLD E R CANCELLATIO 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. Kittitas County AUTHORIZED REPRESENTATIVE 205 W 5TH AVE STE 108 6~£C~~~ ELLENSBURG, WA 98926 @ 1988-201 5ACORD CORPORATION. All nghts reserved . ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD