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ACORD0
<br />CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY)
<br />~ 12/14/2018
<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 pollcy(les) 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 1,u,.,,..,1 Donna Martinez NAME:
<br />1'erril' Lewis. & WI ike Ins r,:ig,ro ext•: (509) 248-3515 I r..oa No): (509) 248-3673
<br />PO Box 1789 :~~SS: dmartinez@tlwins.com
<br />112 S 4th Street INSURER(S) AFFORDING COVERAGE NAICI
<br />Yakima WA 98907 INSURER A: Continental Casualty Company 20443
<br />INSURED INSURERB: Continental Insurance Company 35289
<br />Belsaas & Smith Construction, Inc. INSURERC: Travelers Property Casualty Co of Amer 25674
<br />PO Box 926 INSURERD:
<br />INSURERE :
<br />Ellensburg WA 98926 INSURERF ;
<br />COVERAGES CERTIFICATE NUMBER· 18-19 GASU IF 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 />1'r-¥R TYPE OF INSURANCE INSD WVD POLICY NUMBER IM~i',j'iirmvi rMM,OnlVVVVl LIMITS
<br />X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br />I CLAIMS-MADE [8loccuR
<br />UAMl\\>l: IOttt r'11c-<,
<br />PREMISES /Ea O<:<:utten c:cl $ 100,000 -MEO EXP (Anv one person) s 15,000
<br />A 4032762755 09/01/2018 09/01/2019 PERSONAL & ADV INJURY $ 1,000,000 -GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 =i POLICY [81 ~:g: •LOC PRODUCTS • COMP/OP AGG $ 2,000,000
<br />OTHER: $
<br />AUTOMOBILE LIABILITY ·r,,!;MBlNEO~LE LIMIT
<br />Ea lll:OOOOI $ 1,000,000 -X ANY AUTO I BODILY INJURY (Per person) $ --B OWNED SCHEDULED 4032762738 09/01/2018 09/01/2019 BODILY INJURY (Per accidenl) $ AUTOS ONLY AUTOS -HIRED -NON-OWNED Pl{OPE~Gc'
<br />AUTOS ONLY AUTOS ONLY iPer Acd<la n · $ --$ 1,000,000
<br />X UMBRELLA LIAB
<br />~OCCUR EACH OCCURRENCE $ 1,000,000 -B EXCESS LIAB CLAIMS-MADE 4032762741 09/01/2018 09/01/2019 AGGREGATE $ 1,000,000
<br />OED ] XI R ETENTION -S 1 O,OOO $
<br />WORKERS COMPENSATION I ~~TUTE I Xl~~H-WA Stop Gap
<br />AND EMPLOYERS' LIABILITY YIN
<br />A ANY PROPRIETOR/PARTNER/EXECUTIVE • NIA 4032762755 09/01/2018 09/01/2019 E,L. EACH ACCIDENT $ 1,000,000
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory In NH) E.L. DISEASE -EA EMPLOYEE $ 1,000,000
<br />~m~rp~g~ ~~~PERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000
<br />limit 100,000
<br />Installation Floater
<br />C 6601189R157 09/01/2018 09/01/2019 Deductible 1,000
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Addltlonal Remark• Schedule, may be attached If more apace Is raqulradl
<br />are named as additional insured, including completed operations, per forms CNA75079XX 1016 and CNA74705XX 0115. Coverage is primary per fonTI
<br />CNA74705XX 0115 Waiver of Subrogation applies perform CNA74705XX 0115. Per project applies per form CNA74705XX 0115
<br />Project: Kittitas County, Bloom Pavilion Upgrades, Ellensburg, WA
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DA TE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Kittitas County ACCORDANCE WITH THE POLICY PROVISIONS.
<br />205 W. 5th Avenue
<br />AUTHORIZED REPRESENTATIVE
<br />Suite 108
<br />Ellensburg WA 98926 ~-d--/~il,k I
<br />© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
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