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CERTI FICATE OF LIABI LITY INSURANCE DATE (MM/DD/YYiY) <br />3t11t2021 <br />THIS <br />THETHE <br />ORABETVUEEN <br />lf SUBROGATION lS WAIVED, sublect <br />rlght3 b tho certlflcate holder ln lla'u of <br />to tfie terms and conditions <br />such endo6ement{s).oolicv(lesl must be endorsed. <br />$ls eardficate docs not conferTNSURED, the <br />A statoment onIMPORTANT: lf the c€rtlftcato <br />the policy, certaln Pollcies maY <br />ofAODTTIOI{ALlgholderan <br />endon3ementanrequlre <br />CONTACT NAME: Leslie Casanova <br />PHONE: 800 925-7767 Ext 1 11 FAX: 386677-3292 <br />E.MAILADDRESS: <br />Sportsman's lnsurance AgencY, lnc. <br />PRODUGER: <br />FL 32174Ormond Beach, <br />1364 North US 1, Suite 503 <br />rNsuRER(S) AFFORDING COVERAGE <br />T.H.E, INSURANCE COMPANYINSURER A: <br />INSURER B: <br />INSURER C: <br />INSURED: <br />LOST PAIR RANCH, LLC <br />P.O. BOX 814 <br />SOUTH CLE ELUM WA98943-0814 <br />x <br />'occuRRENcE f] crarrrs r,nnoe <br />[l Hneo nuro & NoN-owNED Auro <br />INSR <br />LTR <br />A <br />3t25120223t25t2021 <br />1PREMISES/OPERATIONS <br />One <br />TO <br />POLICYEFF POLICYEXP <br />(MM/DD/YYYY) (MM/DD/YYYY) <br />GENEMLAGGREGATE NONE <br />PRODUCTS.COMP/OP AGG $ 1,000,000 <br />PERSONAL &ADV. INJURY $ 1,000,000 <br />LIMITSPOLICY NUMBER <br />MED. EXP <br />GENERAL LIABILITY <br />COMMERCIqL GENERAL LIABILIry <br />MASTER POLICY # <br />GG101001 <br />CERTIFICATE# <br />NGC 2917 -03 $ 100,000 <br />$ 10,000 <br />Each Common Cauee <br />AggregateLIQUOR L]ABILITY <br />I occunner.rce <br />EACH OCCURRENCE <br />AGGREGATE <br />I excess LrABrLtrY <br />[occunnence f] cu'tls tueot <br />f]oro In*rNro*s <br />I Y['*V0il$. ! ornen <br />E.L. EACH ACCIDENT <br />E.L. DISEASE - POLICY LIM]T <br />E.L. DISEASE. EA EMPLOYEE <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LLABILITY <br />ANy pRopRrEToR/pARTNER/EXEcurvE g <br />oFF|CER/MEMBER EXCLUDED? Ll <br />(Mand.tory ln NH) <br />ff ves. describecl und€r <br />DESCRIPTION OF OPERATIONS boloil <br />DESCRIPTION OF OPERATIONS'LOCATIONS/SPECIAL ITEMS - CERTIFICATE HOLDER 13 AODED AS AN ADD]TONAL INSURED ' <br />RESPECT TO THE OPERATIONS OF: <br />MANAGERS OR LESSORS OF PRESISES BUT ONLY U'ITH <br />LOST PAIR RANCH, LLC <br />KITTITAS COUNTY IS ADDED AS ADDITIONAL INSURED ON A PRIMARY/NONCONTRIBUTORY BASIS, BUT ONLY WITH <br />RESPECTS TO THE NAMED INSUREDS OPERATIONS. LIABILITY COVEMGE IS NOT EXTENDED FOR ANY OTHER <br />ACTIVITIES <br />sHouLD ANY OF rHE ABOVE DESCRIBED P,O-Ll!i!!:s- EE CANCEL!F-D-EE|o^EE--IEE <br />EliFriiftr6ili'oiiE THdREo-F;NonaE WLL BE DELIyERED lN AccoRDANcE wlrH <br />THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVEfu,(ry <br />KITTITAS COUNTY <br />205 W. sTH, AVE. <br />ELLENSBURG, WA 98926 <br />FMPCOI2011 072013 lncludes copyrighted material of 198&2010 ACORD CORPORAI0N