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ACORD" CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) <br />~ 9/1/2019 8/30/2018 <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 policy, 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 Lockian Companies l:l1!Hif-C1 <br />3280 Peachtree Road NE, Suite #250 fA'J~."rf o Ext): I r8., No): Atlanta GA 30305 E~M_Aj!, ___ <br />(404) 460-3600 <br />IN!\UR E'R/!':I ,_ -.r1"\\1r:DM>J: •IAIC/1 <br />INSURER A: Gemini Insurance Comnan:v 10833 <br />INSURED Summit Food Service, LLC INSURER B: Sentrv Casualtv Co mna nv 2846D <br />1357140 1751 West County Road B, Suite 300 <br />Roseville MN 55113 INSURER C: Sentrv Insurance a Mutual Company 24988 <br />INS.U.RER D: <br />INSURER E.: <br />.INSURER F: <br />COVERAGES CERTIFICATE NUMBER· 1348355.i .. REVISION NUMBER· XXXXXXX . <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 />'&: TYPE OF INSURANCE 1,?~i\-SJWo POLICY NUMBER lr~?~/§fl~, POL ICY _l,)(f'_ l.l 'TT, LIMITS <br />C X COMMERCIAL GENERAL LIABILITY y N 90-18840-06 9/1/2018 9/1/2019 !=AC.H OCCURRENCE $ 1,000 000 D CLAIMS-MADE [x] OCCUR ~AMAGE J?~ENi:EO $ 1,000.000 REMISE 11 o,;cl:ii'mneel <br />rvtED EXP (Any one oersonl $ 5 ,000 -PERSONAL & ADV INJURY $ 1,000.000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGAT.E $ 2 ,000.000 4 POLICY• ~r8T DLoc PRODUCTS -COMP/OP AGG $ 2 ,000.000 <br />OTHER: $ <br />C I AUTOMOBILE LIABILITY N N 90-18840-04 ~AOS) 9/1/20 18 9/ I /20 I 9 ~~~~l':l;;g1~NGLE UMIT $ 1.000.000 <br />C .K.. ANY AUTO 90-18840-05 MA) 9/1/2018 9/1/2019 BODILY INJURY (Per person) $ xxxxxxx -OWNED SCHEDULED BODILY INJURY (Per accident' $ xxxxxxx AUTOS ONLY AUTOS --HIRED NON-OWNED P~OP,~J,\R.JIMAGE AUTOS ONLY AUTOS ONLY 8tlt Ml ' $ xxxxxxx --A X Drive Other GVE100207901(1X1) 9/1/2018 9/1/2019 Excess Limit $ 1.000.000 <br />UMBRELLA LIAB H OCCtJR EACH OCCURRENCE $ xxxxxxx -NOT APPLICABLE EXCESS LIAB CLA l!I\S•MADE AGGREGATE $ xxxxxxx <br />DED I I RETENTION $ $ <br />C WORKERS COMPENSATION N 90-18840-01 9/1/2018 9/1/2019 XI re-TuTE I ,QTH. <br />AND EMPLOYERS" LIABILITY Ylt-l .ER <br />B ANY PROPRIETOR/PARTNER/EXECUTIVE [ill 90-18840-02 (Retro) 9/1/2018 9/1/2019 E.L EACH ACCIDENT $ 1.000,000 OFFICER/MEMBER EXCLUDED? N/A <br />(Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $ 1,000.000 <br />Ir yes, describe under • 1,000.000 DESCRIPTION OF OPERATIONS below 8.L DISEASE • POLICY LIMIT <br />C Hired Anto Phy~ic~l D~m~ge N N 90-1 8840 -04 (AOS) 9/1/2018 9/J/2019 $1,000 Comp/Collision <br />DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Certificate Holder is included as an Additional insured as respects General Liability are required by written contract. <br />CERTIFICATE HOLDER <br />13483555 <br />Kittitas County Jail <br />205 West Fifth Street <br />Ellensburg WA 98926 <br />ACORD 25 (2016/03) <br />RECEIVED <br />SEP O 6 2018 <br />KITTITAS COU NT Y SHt:!',!FF <br />ACCOUN TIN G <br />CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />©1 <br />The ACORD name and logo are registered marks of ACORD <br />I