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--,-lACORD"l--- <br />BELS&SM-OI <br />CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) <br />4116t2021 <br />THIS CERTIFICA TE ts ISSUE D AS A MA TTER OF N FORMA Tro N ON LY AND coN FERS NO RIG HTS UPO N THE CE RTI FICATE HOLDER.THISCERTIFICATEDOESNOTAFFIRMATIVELYORNEGATIVELYAMEND,EXTEN D OR ALTER THE COVERAGE AF FORDE D BY THE POLIC!ESBELOW.THIS CERTIFICATE OF INSURANC E DOES NOT CONSTITUTE A CONTRACT BETWEEN THE tssutNG rNs URER(S),AUTHORIZEDREPRESENTATIVEORPRODUCER,AND THE CERTIFICATE HOLDER. <br />IM PORTANT:the certificate holder ts an ADDITIONAL NSU RED,the policy(ies)must have ADDlTIONAL INSURED provisions or be endorsed.If SUBROGA TION rs WAIVED,subiect to the terms and con d itions ol the policy,certaln may requ tre an endorsement.A statement onthiscertificatedoesnotconfertothecertificaleholderlnlieuofsuch <br />PRODUCER <br />Terril, Lewis & Wilke lnsurance, lnc. <br />P.O. Box 1789 248-3515 248-3673 <br />kima, WA 98907 s.Gom <br />INSURED <br />Belsaas & Smith Construction, lnc. <br />P O Box 926 <br />Ellensburg, WA 98926 <br />rNsuRER B : Continental lnsurance Comoanv 35289 <br />INSURER C : <br />INSURER D : <br />INSURER E : <br />INSURER F : <br />CERTIFICATE MAY MAY <br />ISTHIS CERTITO THAFY T THE OFPOLICIES EINSURANC BELISTED HAVELOW ISSUEDBEEN THETO NSU DRE ABOVENAMED THEFOR PERPOLICY toDINNOTWTHSTANDANYNGDICATED.REQUIREMENT ORTERM coN DITION ANYOF ORCONTRACT OTHER DOCUME WNT RESPECTTH WHTO Htc THI sBEISSUEDORETHPERTAIN,NSURANCE DEDAFFOR THEBY POLIC DESCRIBEDES ISHEREIN BJECTSU TO ALL TERTHE MS,ANDEXCLUSIONS ONSCONDITI SUCHOF LIMITSPOLtCtES.SHOWN MAY BEENHAVE BYREDUCED DPAI CLAIMS. <br />TYPE OF INSURANCE POLICY NUMBER UMITS <br />X <br />100,000 <br />X <br />A COMMERCIAL GENERAL LIABILITY <br />LIMIT <br />POLICY PRO. <br />JECT E <br />OCCURCLAIMS.MADE <br />Work-Site <br />PER: <br />LOC <br />9t1t2020 91112021 <br />GAP <br />LIMIT <br />X <br />Y <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />OWNED <br />AUTOS ONLY <br />HIRED <br />AUTOS ONLY <br />SCHEDULED <br />AUTOS <br />NON-OWNEDAUTOS ONLY <br />911t2020 9t1t2021 <br />x xUMBRELLA LIAB <br />EXCESS LIAB <br />OCCUR <br />CLAIMS.MADE <br />DED x RETENToN $ 1 <br />9t1t2020 911t2021 <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED?(Mandatory ln NH)l <br />tf <br />N'A <br />ls primary <br />SHOULD ANY OF THE ABOVE OESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />I <br />Kittitas Gounty <br />205 West Sth Street <br />Ellensburg, WA 98926 <br />*.""*4/,?"r--e <br />AUTHORIZED REPRESENTATME <br />@ 1988-2015 ACORD CORPOMTION. Alt rights reserved. <br />The AGORD name and logo are registered marks of ACORD <br />ACORD 25 (2016/03)