|
CERTIFICATE OF LIABILITY INSURANCE
<br />COVERAOES CERTIFICATE NUMBER: 11 REVISION NUMBER: O
<br />CERTIFICATE HOI..DER CANCELLATION
<br />173-992-9
<br />KITTATAS COUNTY CORONER 'S OFFICE
<br />507 N NANUM ST STE ,113
<br />ELLENSBURG, WA 98926-2886
<br />110
<br />SHOUI..D ANY OF THE ABOI/E DESCRIBED POLICIES BE CANCELI..ED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE,tl/L,hJ ( 14*
<br />ACORD 25 (2016/03)
<br />@ 1988-20'15 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />DATE
<br />@tfinaz'
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOIDER. 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 HOTDER.
<br />IMPoRTANT: It ths cerfiticate hotder is an ADDtTtoNAL INSURED, tho poticy(i6s) must hav6 ADDtTtoNAL tNsuRED provisions or be endorsed. It
<br />SUBROGATION ls WAIVED, subiect to the tsrms and conditions ot the pollcy, certaln policies may require an ondorssment. A statemsnt on this
<br />certillcate does not conter tiohts lo lhe certlticate holder ln lieu ol such endorsement{sl
<br />PRODUCER
<br />FEDERATED MUTUAL I NSURANCE COMPANY
<br />HOME OFFICE: P.O, BOX 328
<br />CI/VATONNA, MN 55060
<br />F8[tJ"t cr IFNT coNTAeJ cFNTtrP
<br />ll8!i". r*r' nss-aca.asaq lffi r^, snz-aac-aena
<br />E.MAILAnDpF\q- Cl IFNT1:.)NTAaTl:FNTFpATFFnINS aoi,
<br />INSURERISI AFFOEDING CdVFFACF NArc {
<br />lNsuRER Ar FEDERATED IVLJTUAL INSURANCE COMPANY 13935
<br />INSURED
<br />BROOKSIDE FUNERAL HOME & CREMATORY, INC.
<br />PO BOX 1267
<br />MOXEE, WA 98936-1267
<br />173-992-9 INSURER B:
<br />INSURER C:
<br />INSURER OI
<br />INSURER E:
<br />INSURER F:
<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 REQUIREIVENT. TERIV 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 TERMS, EXCLUSIONS
<br />AND CONDITIONS OF SUCH POLICIES. LII\4ITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIIUS.
<br />TYPE OF INSURANCE POLICY NUMEER POLICY EFF POLICY SXP LIMITS
<br />A
<br />COMMERCI& GENERA LIABILITY
<br />]"*rr.roo, lx-l o""u*
<br />BUSINESS OMER'S LIABILITY
<br />rL AGGREGATE LIMIT APPLIES PER
<br />,o.,." l-l3gg | l.o"
<br />CTHER:
<br />N N 608761 1 11t30t2019 11t30t2020
<br />EACH OCCURRENCE $1,000,000
<br />DAMACE TO RENTEDDDArr.E. /r. ^.-,,,E6-61 $100,000
<br />x MED EXP l$y one personl $s,000
<br />PERSONAL & ADV INJURY $1.000,000
<br />x
<br />OENERAL AOOREOATE $2,000,000
<br />PRODUCTS . COMP/OP ACO $2,000,000
<br />A
<br />AUTOMOBILE LIABILITY
<br />x ANY AUTO
<br />OWTED AUTOS ONLY
<br />HIRED AUTOS ONLY
<br />SCHEDULEO
<br />AUTOS
<br />NON.OWNEO
<br />AUTOS ONLY
<br />N N 6087612 11t30t2019 11n0t2020
<br />$1,000,000
<br />BODILY INJURY (Per pcr3on)
<br />BODILY INJURY {P.r rccidsnl)
<br />x UMBRELLA LIAB
<br />EXCESS LIAB
<br />x OCCUF
<br />CLAMS.MEE N N 6087613 11t30t2019 11not2020
<br />EACH OCCURRENCE $2,ooo,ooo
<br />ACGRECATE $2,000,000
<br />DED RETENTION
<br />A
<br />ffi
<br />AII€ EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR'PARTNER/EXECUTIVE
<br />OFFICEVMEMgER EXCLUDED?
<br />(Mandatory in NHI
<br />It yer, d4cribe under
<br />DESCRIPTION OF OPERATIONS below
<br />I N N 608761 1 11t30t2019 11f30t2020
<br />lren srnrurr I
<br />OTH.
<br />ER
<br />E.L, EACH ACCIDENT $1,000,000
<br />E.L. DISENE .EA EMPLOYEE $1,000,000
<br />E,L DISEASE. POLICY LIMIT $1,000,000
<br />DEscRlPTloN oF oPERATIoNS / LocATloNs i VEHICLES (AcoRD 101, tuditional Rcmarb schcdule. may be afrded if more sgace is requiredl
<br />STOP-GAP (EI'IPLOYER'S LIABILITY) COVERED STATE(S) lTA
<br />5OO E I{OUNTAIN VIEW, ELLENSBURG, l{A
|