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a►l® �CERTIFICATE OF LIABILITY INSURANCE
<br />EIM.mNYY Y)
<br />113NQ2020
<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 BELOW. THIS
<br />CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSUREINS), AUTHORIZED REPRESENTATIVE OR
<br />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. If
<br />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 comer rharts to the certificate holder In )leu of such endorsements .
<br />PRODUCER
<br />FEDERATED MUTUAL INSURANCE COMPANY
<br />HOME OFFICE: P.O. BOX 328
<br />CONTACT
<br />CLIENT CONTACT CER
<br />FN, Np Ezt:88&333-4999 F� an, 5074464664
<br />nouAl¢SE, CLIENTCO TACTC TER FEDI .COM
<br />OWATONNA, MN 55060
<br />INSURERS) AFFORDING COVERAGE
<br />NAION
<br />11/30/2020
<br />INSURER A: FEDERATED MUTUAL INSURANCE COMPANY
<br />13935
<br />DAMAGE TO RENTEp $100 ,000
<br />MED EXP IMY Con penall $5,000
<br />INSURED 173-992-9
<br />INSURER B:
<br />BROOKSIDE FUNERAL HOME 8 CREMATORY, INC.
<br />PO BOX 1267
<br />INSURER V.
<br />OENERAL AOOREOATE $2,000,000
<br />INSURER D:
<br />MOXEE, WA 98936-1267
<br />INSURER E:
<br />LIABILITY
<br />AUTOBODILY
<br />AUTOS OXLT AUTOSULLC
<br />HIRED lWTO60NLY NONOWNED
<br />AUTOS ONLY
<br />N
<br />INSURER F:
<br />6037612
<br />11MG2019
<br />COVERAGES CERTIFICATE NUMBER: 11 REVISION NUMBER:0
<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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS
<br />AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />TYPE OF INSURANCE
<br />16L
<br />SUER
<br />POLICY HUMBER
<br />POLICY YW
<br />POLICY EXP
<br />LIMITS
<br />A
<br />WILL BE DELIVERED IN
<br />MMERCIAL GENERAL LIABILITY
<br />CLAIMS-MPOEOCCUR
<br />Hires OWNER'S LIABILITY
<br />TX
<br />N
<br />N
<br />6037611
<br />11/30/2019
<br />11/30/2020
<br />EACH OCCURRENCE $1,OOD,WD
<br />J4,,,
<br />DAMAGE TO RENTEp $100 ,000
<br />MED EXP IMY Con penall $5,000
<br />O
<br />X
<br />PERSONAL a ADV INJURY $1,0001000
<br />ry'L AOORE TEPRO LIMIT MPMEB CER:
<br />POLICY JECT ❑LOC
<br />OTXFR:
<br />OENERAL AOOREOATE $2,000,000
<br />PRODUCTS - COMPIOP ADS $2,000,000
<br />AOVMED
<br />AUTOMOBILE
<br />IANY
<br />LIABILITY
<br />AUTOBODILY
<br />AUTOS OXLT AUTOSULLC
<br />HIRED lWTO60NLY NONOWNED
<br />AUTOS ONLY
<br />N
<br />N
<br />6037612
<br />11MG2019
<br />11/i.0/2020
<br />COMENEDI,5INDLE UMIT $1,009,000
<br />INJURY(Per person)
<br />BODILY INJURY)Per smiMnQ
<br />Fp OPERIY DAMAGE
<br />A
<br />X
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />CLUMS-MAGE
<br />N
<br />N
<br />6037613
<br />11/302019
<br />11/30/2020
<br />EACH OCCURRENCE $2,000,000
<br />AOOREOATE $2,000,000
<br />DEC RETENTION
<br />A
<br />AND EMPLOLIABILITY YIN
<br />ANY PROPRIETORIPARTNERIEXECUTIVF
<br />OFFICERIMEM6ER FXCWDE%
<br />(Mtlebry in NHl
<br />11 M. domne, under
<br />DESCRIPTION OF OPERATIONS GeloW
<br />NIA
<br />N
<br />6037611
<br />11/30/2019
<br />11/302020
<br />PERSTATUTE CER
<br />E. L. EACH ACCIDENT $1,900,000
<br />E. L. DISEASE - EA EMPLOYEE $1,000,000
<br />L DISEASE - PoIICT LIMIT .
<br />E $1,000,000
<br />L '177
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101. AAditionel Remmar, 6deWle, may M dNNed it mom spMe is mmired)
<br />$TOP -GAP (EMPLOYER'S LIABILITY) COVERED STATES) WA
<br />500 E MOUNTAIN VIEW, ELLENSBURG, NA
<br />CERTIFICATE HOLDER CANCELLATION
<br />173.992-9
<br />110
<br />KITTATAS COUNTY CORONER'S OFFICE
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />507 N NANUM ST STE 113
<br />THE EXPIRATION DATE THEREOF, NOTICE
<br />WILL BE DELIVERED IN
<br />ELLENSBURG, WA 98926-2886
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />J4,,,
<br />O ISM -2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ADORE,
<br />
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