SH19-003 PSS Agreement - Laserfiche WebLink

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AC"ORU� F JW �--� CERTIFICATE OF LIABILITY INSURANCE R001 DATE (NIl&`DD/YYYY) 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(s). PRODUCER MICHELETTI INSURANCE SERVICES/PHS 556314 P: (866) 467-8730 F: (888) 443-6112 PO BOX 33015 SAN ANTONIO TX 78265 CONTACT NAME: (A/C,NEo,Ext): (866) 467-8730 (Ac.No): (888) 443-6112 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURERA: Sentinel Ins Co LTD 11000 INSURED LAW ENFORCEMENT PSYCHOLOGICAL SERVICES, INC. 15251 NATIONAL AVE STE 201 L O S GAT O S CA 95032 INSURER B: INSURER C: INSURER D: INSURER E: IF: 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. IN.SR LTR TYPE OF INSURANCE ADDL I SUBR WC' POLICYNUMBER POLICYEFF MM/DD/YYYY) POLICYEXP M � LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s2, 000, QQQ CLAIMS -MADE OCCUR DAMAGE TO RENTED $1, 000, 000 PREMISES (Ea occurrence) MED EXP (Any one person) $10, 000 A X General Liab 57 SBA BZ5288 04/01/2018 04/01/2019 PERSONAL & ADV INJURY s2, 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE -4,000,000 POLICY PRO- FX—] LOC JECT PRODUCTS - COMP/OP AGG $ 4 , 000, 000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT s2, (Ea accident) 2 00O 000 BODILY INJURY (Per person) $ ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS 57 SBA B Z 5 2 8 8 04/01/2018 04/01/2019 BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $1f000,000 A EXCESS LIAB CLAIMS -MADE 57 SBA B Z 5 2 8 8 04/01/2018 04/01/2019 AGGREGATE $1f000,000 DED X RETENTION $ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY STATUTE I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED?NIA (Mandatory in NH) F-1 r E.L. DISEASE- EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below $ E.L. DISEASE -POLICY LIMIT DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe 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 SS0008 attached to this policy. CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 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 i t t i t a s County 205 W 5TH AVE STE 108 AUTHORIZED REPRESENTATIVE �J ELLENSBURG, WA 98926 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD