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�0 �J CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 09/18/2019 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 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 CONTACT NAME: Rothert Insurance c/o Lael Insurance and Financial Svs PHONE FAX (A/C. No. Ext): A/C No: ADDRESS.- 2301 W Dolarway Road Suite 5 INSURER(S) AFFORDING COVERAGE NAIL# INSURERA: Capitol Specialty Insurance Co Ellensburg WA 98926 INSURED INSURER B; Huffman Farms Hilary Huffman, dba INSURER C: 440 Buckboard Lane INSURER D: INSURER E: Ellensburq WA 98926 INSURER F: COVERAGES CERTIFICATE NUMBER: RPVlslnrd hlllhnRl=R• 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. _SR Thl LTR TYPE OF INSURANCE ADDPSUORF INSD WVD POLICY NUMBER PO • MM1QDJYYYY POLICY EXP (MMIDD/YYYY LIMITS EACH OCCURRENCE g 1.000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE %� OCCUR ❑AMA E REN PREMISE re $ 100,000 MED EXP (Any one persoM S 5,000 PERSONAL &ADV INJURY $ 1,000,000 A Y CS19004358-01 09/21/2019 10/28/2019 GE LAGGR.EGATE LIMITAPPLIES PER: POLICY❑ JE�� LOC HOTHER GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMP/OPAGG $ Included $ AUTOMOBILE LIABILITY COMB121 S NGLE LIMIT $ a arsircdi 3nl ANYAUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident $ ( ) NON -OWNED HIRED AUTOS AUTOS PIiOPEI�'I'Y DAMAGE era y $ $ UMBRELLA LIABOCCUR HCLAIMS-MADE EACH OCCURRENCE $ EXCESS LIAB AGGREGATE $$ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N IPER OTH- .. _L_$TATQTE I E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? N NIA EL. DISEASE -EA EMPLOYEE $ (Mandatory in NH) If yes, describe under E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) THIS CONTRACT IS REGISTERED AND DELIVERED AS A SURPLUS LINE COVERAGE UNDER THE INSURANCE CODE OF THE STATE OF WASHINGTON, TITLE 48 RCW. IT IS NOT PROTECTED BY ANY WASHINGTON STATE GUARANTY ASSOCIATION LAW. RON ROTHERT INSURANCE, INC. / Pumpking Patch, Haunted Forest Kittitas Country, Its agents employees and assigns 205 W 5th Ave Ellensburg WA 98926 L.ANL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD