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AC(:>RO® <br />III CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MM/DDIYYYY) <br />1/6/2021 <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: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />NAME: TylerKerlee <br />Eastside Insurance Group, LLC DBA Path Insurance S <br />AHONE All <br />/C No Ext (A/C, No): <br />ADDRESS: tyler@pathms.com <br />17530 Northeast Union Hill Road <br />Suite 160 <br />INSURER(S) AFFORDING COVERAGE NAIC # <br />Redmond WA 98052 <br />INSURER A : SENTINEL INS CO LTD 11000 <br />INSURED <br />INSURER B <br />509 Facility Services Inc <br />INSURER C : <br />400 Pebble Beach Dr <br />INSURER D: <br />INSURER E: <br />AUTOMOBILE <br />Cie Elum WA 98922 <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER- RFVISInN KIHMRFR- <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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />LTR <br />TYPE OF INSURANCE <br />INSD <br />WVD <br />POLICY NUMBER <br />(MM/DDNYYY) <br />(MM/DD/MY) <br />LIMITS <br />A <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE © OCCUR <br />Y <br />52SBMAC2843 <br />11/28/2020 <br />11/28/2021 <br />EACH OCCURRENCE $ 1,000,000 <br />ocence) $ 1,000,000 <br />PREMISES (Ea cun <br />MED EXP (Any one person) $ 10,000 <br />PERSONAL a ADV INJURY $ 1,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER <br />POLICY © PRO- ❑ <br />JECT LOC <br />OTHER: <br />GENERAL AGGREGATE $ 2,000,000 <br />PRODUCTS -COMP/OP AGG $ 2,000,000 <br />$ <br />A <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />y <br />52SBMAC2843 <br />11/28/2020 <br />11/28/2021 <br />Ea a.,aent $ 1,000,000 <br />BODILY INJURY (Per person) $ <br />BODILY INJURY (Peraccident) $ <br />(Per accident) $ <br />A <br />K <br />UMBRELLA LIAB <br />EXCESS LIAB <br />'K <br />OCCUR <br />CLAIMS -MADE <br />Y <br />TBD <br />11/28/2020 <br />11/28/2021 <br />EACH OCCURRENCE $ 2,000,000 <br />AGGREGATE $ 2,000,000 <br />DED I I RETENTION $ <br />$ <br />A <br />ORKERS COMPENSATION <br />ND EMPLOYERS' LIABILITY Y / N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICERIMEMBER EXCLUDED? <br />Mandatory In NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />N / A <br />52SBMAC2843 <br />11/28/2020 <br />11/28/2021 <br />STATUTE I I ER <br />E.L. EACH ACCIDENT $ 1,000,000 <br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000 <br />E.L. DISEASE - POLICY LIMIT $ 1,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />CERTIFICATE HOLDER rAklii I eTInN <br />©1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Kittitas County <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />205 West 5th Ave Ste 108 <br />AUTHORIZED REPRESENTATIVE <br />Ellensburg WA WA 98926 <br />©1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />