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ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) ~ 2/1/2019 THIS CERTIFICATE IS 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(s). PRODUCER ~~:i~cT Allison Baraa Hall & Compan y rA~9N,.t l'vt\• 360-626-2007 I f ffc Nol: 360-626-2007 19660 10th Ave NE ~t1lJ~ss , abarQa@hallandcompany .com Poulsbo WA 98370 INSURER($) AFFORDING COVERAGE NAIC# INSURER A : Hartford Casualtv Insurance Company 29424 INSURED 468 INSURER B : Sentinel Insurance Comoanv 11000 The Watershed Company INSURER c : Argonaut Insurance Company 19801 750 6th Street South Kirkland WA 98033 INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1642572026 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 C ERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED B Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EX CLUSI O NS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE ,.,en wun POLICY NUMBER IMM/DD/YYYYl IMM/DD/YYYYl A X COMMERCIAL GENERAL LIABILITY 52SBA LG6505 9/30/2018 9/30/2019 EA CH OCCURR ENC E $2,000 ,000 -D CLA IMS-MADE 0 OCC UR DA MAGE TO RENTED PREM ISES /Ea occurre nce \ $300 ,000 MED EX P (A ny one perso n) $10,000 - PERS ON AL & ADV INJURY $2 ,000,000 - GEN 'L AGGR EGA TE LI MIT APP LIE S PER : GENE RAL AGGRE GATE $4 ,000,000 ~ 0 PRO-•LOC PRODU CTS -COMP /OP AGG $4 ,000,000 PO LI CY JECT OTHER: $ B AUTOMOBILE LIABILITY 52UEC JR5898 9/30 /2018 9/30 /20 19 fE~~~~~l lN GLE LI MIT $1,000,000 -X ANY AUTO BODIL Y INJ URY (Per pe rson) $ --OW NE D SC HEDULED BOD ILY INJURY (Per accident) $ -AUTOS ON LY ~ AUTOS X HIRED X NON -OW NED PRO PERTY DAM AGE $ AUTOS ON LY AUTOS ONLY /Per accid ent\ -~ $ A X UMBRELLA LIAB M OCCUR 52SBALG6505 9/30 /201 8 9/30 /2019 EAC H OCC URRE NCE $1 ,000,000 - EXCESS LIAB CLA IMS -MADE AGGR EGATE $1,000,000 DED I X I RETENTI ON$ 1n nnn $ A WORKERS COMPENSATION 52SBA LG6505 9/30 /201 8 9/30/2019 I PE R IX I OTH-W A Stop Gap AND EMPLOYERS' LIABILITY ST ATUTE ER Y/N ANYPROPR IETOR/PA RT NER/EXECU TIV E • N/A E.L. EA CH ACC IDENT $1,000 ,000 OFFICER/M EMBE R EXCLU DED ? (Mandatory in NH) E.L. DI SEA SE - EA EMP LOY EE $1,000 ,000 If y es, describe under E.L. DISE AS E - POLI CY LIM IT $1,000 ,000 DE SCR IPTI ON OF OPE RA TI ONS be low C Pro/e ss iona l Liab Claims Made 121AE0001 97 300 9/30 /201 8 9/30/2019 $1,000,000 Per Cla im $1 ,000 ,000 Agg re gate DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (ACORD 101 , Additional Remarks Schedule , may be attach ed if more space is requ ired) Project: Critical Areas Ordinance Review and Draft Update The certificate holder is an additional insured per the attached. 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. K ittitas County 205 W 5th Ave, Suite 108 AUTHORIZED REPRESENTATIVE Ellensburg WA 98926 au; z -;/J_ I © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD