|
~ RIVERS0-01 MGRIFFANTI
<br />ACORD" CERTIFICATE OF LIABILITY INSURANCE I
<br />DATE IMM/00/YYYYl
<br />~ 11/08/2017
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY 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(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the pollcy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER License# CA#0658748 Sl?ti!~CT
<br />AHT Insurance ritJ~N,;o , Ext): (703) 777-2341 I r~. Nol:(7-03) 771-1852 20 S. KJng Street
<br />Leesburg , VA 20175 ~~\?c:c:,
<br />INSURERISl AFFORDING COVERAGE NAIC#
<br />INSURER A: Hartford Accident and lndemnitv Comoanv 22357
<br />INSURED INSURER B: Sentinel Insurance Comoanv Ltd 11000
<br />American Rivers, Inc. INSURER c: Hartford Casualtv Insurance Comoanv 29424
<br />1101 14th Street, NW, Suite 1400 INSURER D : Hartford Underwriters Insurance Comoanv 30104
<br />Washington, DC 20005 INSURERE:
<br />INSURER F:
<br />COVERAGES C ERTIFICATE NUMBER· REVISION NUMBER·
<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 WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES . LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS .
<br />INSR TYPE OF INSURANCE ~8.\l,~ w.w~ POLICY NUMBER POLICY EFF _ _POUCYEX~ LIMITS LTR
<br />A X COMMERCIAL GENERAL LIABILITY EACH .OCCURRENCE. $ 1,000,000 ,--~ CLAIMS-MADE 0 OCCUR ~\~iU9 .. ~N1_~ _, 300,000 X X 42UUNZl6055 11/08/2017 11/08/2018 $ -10,000 MED EXP /Anv one nersCllll $ ,-1,000,000 PERSONAL & ADV INJURY $ ,-2,000,000 ALAGG~ LIMIT APPLIES PER: GENERAL AGGREGATE. $_
<br />POLICY ~f8f • LOC PRODUCTS -COMP/OP AGG $ 2,000,000
<br />OTHER EBL AGG"REGA TE $ 2,000,000
<br />B AUTOMOBILE LIABILITY C9;11Bt[IJEO SINGLE UMIT
<br />$ 1,000,000 --ANY AUTO X X 42UUNZl6055 11/08/2017 11/08/2018 BODILY INJ URY /Per nersonl $ I-OWNED -SCHEDULED --AUTOS ONLY -AUTOS BODILY JNJURY IPe,: accidenll $
<br />X ~1%PsoNLY X ~S~®.t~·-rf~~8AMAGE $ ,_ -
<br />$.
<br />C X UMBREL.lA LIAB ,~ OCCUR E.ACH OCCURRE.111.CE $. 4,0U0,000 -42RHUZl6471 11/08/2017 11/08/2018 4,000,000 EXCESS LIAB CLAIMS-MADE AGGRE.GATE. $
<br />OED I X I RETENTION$ 10,000 $_
<br />D WORKERS COMPENSATION X I ~~fTlm= I l ~iH-ANO EMPLOYERS' LIABILITY y I
<br />X 42WECK7493 11/08/2017 11/08/2018 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE • E L E.ACH ACCIDENT $ 11,1':FICEfllM!jM~!Ffi EXCLUDED? N/A 1,000,000 anchl ory n ) E L DISEASE -EA E.MPLOYEE $ ~~it~rttt~ ot~PERATIONS below EL DISEASE -POLICY LIMIT $ 1,000,000
<br />DESCRIPTION OF OPERATIONS/LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, ma y, bu 1tluhad if more ap~co.ls required I
<br />Certificate Holder, the County, its successors, and assigns, and the respective directors, officers, em ploye es of the County and its successors and assigns
<br />are Additional Insureds on a primary and non-contributory basis under General Liability and Automobile Liability as required by written contract. A Waiver of
<br />Subrogation applies in favor of Certifcate Holder under General Liability, Automobile Liability and Workers Compensation as required by written contract.
<br />CERTIFICATE HOLDER CANCEL LA TION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Kittitas County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />205 West 5th Avenue, Suite 108
<br />Ellensburg, WA 98926
<br />AUTHORIZED REPRESENTATIVE
<br />I
<br />~~Jfj
<br />.
<br />ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
|