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COVERAGES CERTIFICATE NUMBER: 11 REVISION NUMBER:O
<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 />WMO9
<br />A� CERTIFICATE OF LIABILITY INSURANCE
<br />�,
<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 INSURER(S), 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 Confer rl ms to the Certificate holder In )leu of such endorsement B .
<br />PRODUCER
<br />FEDERATED MUTUAL INSURANCE COMPANY
<br />HOME OFFICE: P.O. BOX 328
<br />CONTACT
<br />NAME: CLIENT CONTACT CENTER
<br />AMMxO Fx1: 888-333-490.9 Mo A: 507.946-4664
<br />ADDRRESS, CUENTCONTACTCENTER FEDINS. OM
<br />OWATONNA, MN 55060
<br />INSURERS) AFFORDING COVERAGE NAION
<br />EACH OCCURRENCE $1,OOD,ODO
<br />INSURER A: FEDERATED MUTUAL INSURANCE COMPANY 13935
<br />DAMAGE TO RENTED $1OD,000
<br />INSURED 773-992_9
<br />INSURER B:
<br />BROOKSIDE FUNERAL HOME & CREMATORY, INC.
<br />PO BOX 1267
<br />INSURER C:
<br />INSURER D:
<br />MOXEE, WA 98936-1267
<br />INSURER E:
<br />PRODUCTS - COMPIOP AGO $2,000,000
<br />UIURER F:
<br />A
<br />COVERAGES CERTIFICATE NUMBER: 11 REVISION NUMBER:O
<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 />INER
<br />LTR
<br />TYPE OF INSURANCE
<br />OL
<br />IXSR
<br />SUOR
<br />VIVO
<br />WUN
<br />POUCY NUMBER
<br />POLICYEFF
<br />MMIOOIYYYY
<br />POLICY EXP
<br />N.C.,"
<br />LIMITS
<br />A
<br />WILL BE DELIVERED IN
<br />COMMERCIAL OENERP U."BLUY
<br />..MS MME ❑X pCOUR
<br />BUSINESS OWNER'S LIABILITY
<br />N
<br />N
<br />6087611
<br />11(30(2019
<br />11!30/2020
<br />EACH OCCURRENCE $1,OOD,ODO
<br />DAMAGE TO RENTED $1OD,000
<br />X
<br />MED SEP (My CM penaN $5,ODO
<br />GEX'L
<br />X
<br />4
<br />PERSONAL& ADV INJURY $1,000,000
<br />ADORE)[,ME LIMIT APPNES PER:
<br />POLICY UJFCT ❑LOC
<br />OTHER:
<br />OENERAL AOOREOATE $2,000,000
<br />PRODUCTS - COMPIOP AGO $2,000,000
<br />A
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />ANY AUTO
<br />OVINE. MTOSONLY MliosU�D
<br />HIRED AUTOS ONLY ALTOSONL
<br />N
<br />N
<br />6067612
<br />11/30/2019
<br />1173072020
<br />EOMINNSEEDDSINGLE MMR $1000,000
<br />BO."UNURY IF."....)
<br />Aa
<br />BODILY INJURY IFer aMn4
<br />P%*1ER,TYoMIAGE
<br />A
<br />X
<br />UMBRELW LIAB
<br />E%CESS LIAO..M.
<br />X
<br />OCCUR
<br />ADE
<br />N
<br />N
<br />6087613
<br />11(3072019
<br />1173072020
<br />EPLH OCCURRENCE $2,000,000
<br />AGGREGATE $2,000,000
<br />DED RETExTIOn
<br />A
<br />ATRBN
<br />MIB EMPLOYERS'LIgBILITY yy
<br />ANY PROPRIETORIPARTNER1EXECUTIVE
<br />OFFICERMEMBER EXCLUDEDi
<br />IMstlabry in NH)
<br />Ryn, Gmorite unEer
<br />DESCRIPTION OF OPERATIONS belpv
<br />XIA
<br />N
<br />6087611
<br />11/3072019
<br />11/30/2020
<br />PER STATUTE GER
<br />E.L. EACH ACCIDENT $1,009,000
<br />E.L. DISEASE EA EMPLOYEE $1,OD%oOD
<br />L DISEASE POLICY OMIT E. $1,000ADO
<br />DESCRIPTION OF OPERATIONS I LOCATIONS, VEHICLES (MORD 101. M&IN.1 Rem.Wa Si ule. mey M eNNeE it DI.. fpex is rMuired)
<br />STOP -GAP (EMPLOYER'S LIABILITY) COVERED STATE(S) WA
<br />500 E MOUNTAIN VIEW, ELLENSBURG, WA
<br />CERTIFICATE HOLDER CANCELLATION
<br />173-9925
<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 98928.2886
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATTII/VEE
<br />7I�' ✓WVV1N/ V
<br />/ VV �i
<br />(D IM -2015 ACORD CORPORATION. MI rights reserved.
<br />ADDING 25 (2011003) The ACORD name and logo are registered (narks of ACORD
<br />
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