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~ FJW A C>Ra' CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY)
<br />'---' ROOl 1 /23/20 1 8
<br />THIS CERTIFICATEIS 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 this
<br />certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER i.;;m,.,crr
<br />"'JIME:'
<br />MICHELETTI INSURANCE SERVICES/PHS PtlQHE ( 8 66) 467 -8730 r.v: 443 -6112 (NC. No, Ext): (1'/C . No): ( 8 8 8 )
<br />55 6 314 P: (866) 467-8730 F: ( 888 ) 443-6112 E-MAIL
<br />ADDRESS:
<br />PO BOX 33015 INSURER(S) AFFORDING COVERAGE NAJC#
<br />SAN ANTONIO TX 78 2 65 INSU RE R A: Sentine l I ns Co LTD 11000
<br />INSURED INSURER B
<br />LAW ENFORCEMENT PSYCHOLOGICAL INSURER C
<br />SERVICES, INC. INSUR ER Do
<br />15251 NATIONAL AVE STE 201 INSURERE .
<br />LOS GATOS CA 95032 INSUR ER F :
<br />COVERAGES CERTIFICATE 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
<br />TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWIN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR TYPE OF INSURANCE AIJDL SUBR POLICY NUMBER POL/CYEFF POLICY EXP LIMITS I.TR ·~!~fl wvn fMMR)fJIYYYY}
<br />COMMERCIAL GENERAL LIABILITY EACH OC CURRENCE ,2, 000, 000
<br />I C LAIMS-MADE ~OCCUR DAMAGE TO RENTED $1,000,000 PREMISES (Ea occurrence)
<br />A X General Liab 57 SBA BZ5288 04/01/2018 04/01/2019 MED EXP (Any one person) ,10, 000 --PERSONAL & ADV INJURY ,2, 000, 000 --GEN'L'AGGREGATE LIMIT APPLIES PER: GENERAL AGG REGATE ,4, 0001 000 Fl POLI C'f D j:gT 0 LOG PRODUCTS. COMP/OP AGG ,4, 000, 000
<br />OTHER: "'
<br />AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT f2 , 000, 0 0 0 (Ea accident) ,-..
<br />ANY AUTO BODILY INJURY (Per person) $ ,-.. OWNED -SCHEDULED A 57 SBA BZ5288 04/01/2018 04/01/2019 BODILY INJUR Y (Per acc iden t) $ ,-.. AUT OS O NLY ,--A UTOS
<br />X HIRED X NON-OWNED PROPE RTY DAM AGE s AUTOS ONLY AUTOS ONLY (Per acci dent) ,-.. ,--
<br />~
<br />X UMBRELLA LIAB H OCCUR EACH OCCURRE NCE i l, 000, 000 -A EXCESS LIAB CLAIMS-MADE 57 SBA BZ5288 04/01/2 018 04/01/2019 AGGREGATE d , 000, 000
<br />~ X IRS111/fflOU$ 1 0 ,000 t
<br />WORKERS CXJ.JJ.P tJ,J_S:;t TWN !PER I I~~-AND EMPLUYERS ' 1,/ARfllTY STATUTE
<br />ANY PROPRIETO R/PARTNER/EXECUTIVE Y/N E L, EACH ACCIDENT J
<br />OFFICER/MEMBER EXCLUDED? • NIA ,--• (Mandatory In NH) E L, DISEASE-EA EMPLOYEE
<br />,--
<br />If yes, describe under E.L DISEASE· POLIC Y LIM IT $
<br />DESCRIPTION OF OPERATIONS below
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Those usual to the Insured's Operations. Certificate holder is an additional 11
<br />insured per the Busine ss Liability Coverage Form SS0008 attached to this
<br />policy.
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
<br />BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE
<br />DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Kittitas County AUTHORIZED REPRESENTATIVE
<br />20 5 W 5TH AVE STE 108 6' ~ £ C.t&~
<br />ELLENSBURG, WA 98926
<br />,@ 1988-2015 ACORD CORP0RA TION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
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