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4|.ACORv D' <br />CENTPAV-o2 <br />CERT¡FICATE OF LIABILITY INSURANCE DATE (MM/DD'YYYY} <br />5t17t2019 <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: lf the certificate holder is an ADDITIONAL INSURED, the policy(iês) must have ADDITIONAL INSURED provisions or be endorsed. <br />lf SUBROGATION lS WAIVED, subject <br />this certificate does not confer rights to <br />to the terms and conditions of the policy, certa¡n policies may require an endorsement. A statement on <br />the certificate holder in Iieu of such endorsement(s), <br />PRODUCER <br />Terril, Lewis & Wilke lnsurance, lnc. <br />P.O. Box 1789 <br />Yakima, WA 98907 <br />CONTACTNÅMF! <br />fJ8.tF". r*o, (509) 248-3515 fÆð, H"r'(509) 248-3673 <br />INSURER{SI AFFORDING COVERAGE NÂIC T <br />TNS1JRER a,western National Mutual lnsurance co 15377 <br />INSURED <br />Central Paving, LLC <br />PO Box 599 <br />Ellensburg, WA 98926 <br />IÀIS1IRER B : <br />INSIIRFR C : <br />INSIIRFR D: <br />INSURER F <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOWHAVEBEENISSUEDTOTHEINSUREDNAMEDABOVEFORTHEPOLICYPERIOD <br />INDICATED. NoTWTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOROTHERDOCUMENTWTHRESPECTTO'UI/I-IICHTHIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREINISSUBJECTTOALLTHETERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHO\^/N MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSRITR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EXP LIMITS <br />A X COMMERCIAL GENERAL LIABILITY <br />CLAIMS.MADE OCCUR <br />LIMIT APPLIES <br />PRO-JECT I I <br />PER: <br />LOCPOLICY <br />X cPP1'.t76974 12t1'U20't8 12t1'1t2019 <br />FAllH ô'IìI IRRFNI]tr s 1,000,000 <br />ß 100,000 <br />Mtrn trYP lÀñv ôña ôêrcôñì ç 5,000 <br />PFPqôNÂI ¿ ÂD\/ IN II IRY ç 1,000,000 <br />êFNtrRÂI ÂêêPtrGÀTF ß 2,000,000 <br />PRônt reTs - côMprôp ÀGG s 2,000,000 <br />WA STOP GAP s 1,000,000 <br />A AUTOMOBILE LIABILITY <br />ANY AUTO <br />OVVNED <br />AUTOS ONLY <br />HIRED <br />AUTOS ONLY <br />X SCHEDULED <br />AUTOS <br />NON-OWNED <br />AUTOS ONLYXX <br />cPPl I 76500 12t1il2018 ,t2t11t2019 <br />g 1,000,000 <br />BODILY INJtJRY lPer Derson)s <br />BODILY INJURY lPer accident)$ <br />Jer A <br />s <br />A X UMBRELLA LIAB <br />EXCESS LIAB <br />X OCCUR <br />CLAIMS-MADE uM81029767 12t11t2018 12t11t2019 <br />EACH OCCURRENCE q 2,000,0o0 <br />AGGREGATE c 2,000,000 <br />DED RÊTENTION $q <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIEIOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED?(Mandatory in NHI <br />lf ves, descr¡be und€r <br />nÉSCRIPTIôN ôF OPFRATIôNS têlôw <br />N/A <br />PER <br />STÂTI ITF <br />OTH- <br />FR <br />E L EACH ACCIDENT $ <br />E L DISEASE. EA EMPLOYEE s <br />F I DISEASE - POLICY LIMIT s <br />DESCRTPTTONOFOPERATIONS/LOCATIONStVEHICLES (ACORDl0l,AdditionalRemarksSchedule,4qyb_e,attqc¡gd-tmoç9P_i9e_l-sF_qq¡lell _. <br />K-¡ttiaá; öıüntyìiJ'of¡cãié, ãóêñiJ áñO employees are adititional insured per forni WNGL49 0715 and WNGA27'0616. Primary and Non-Gontributory applies per <br />form WNGL4907l5. Waiver of Subrogation appl¡es per form WNGL39 0818 and WNCA27 0616 Gompleted operat¡ons is provided per WNGL84 0715. <br />Endorsements are attached <br />Kitt¡tas County <br />205 West 5th Avenue <br />Suite 108 <br />Ellensburg, WA 98926 <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*: n lú'[-,1 <br />@ 1988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />ACORD 2512016t031