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AC© ® <br />REQUIREMENT, TERM OR CONDITION OFANYCONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE <br />DATEIMM/DD/YYW) <br />11� <br />CERTIFICATE OF LIABILITY INSURANCE <br />08/24/2021 <br />THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT <br />AFFIRMATIVELYOR NEGATIVELY AMEND, EXTEND OR ALTERTHE COVERAGE AFFORDED BYTHE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT <br />CONSTITUTE A COMPACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER ANDTHE CERTIFICATE HOLDER <br />IMPORTANT: Ifthe certificate holder Is an ADDITIONAL <br />INSURED, the policy(les) mu# be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions ofthe <br />policy, certain policies may require endorsement. Astatement on this certificate does not confer rights to the Certificate holder In lieu of such endorsements. <br />PRODUCER <br />INSR <br />CONTACT <br />NASW RRG Plan Administrator <br />1200 East Glen Avenue <br />EFF <br />NAME: <br />PHONE <br />WC, No, EAX <br />FAX <br />We No): <br />Peoria Heights, IL 61616-5348 <br />E MAL <br />ADDRESS <br />INSURERfS1 AFFORDING COVERAGE NAIC# <br />DAMAGE TO RENTED PREMISES $ <br />INSURED <br />INSURERA: NASW Risk Retention Group 14366 <br />INSURER 13- <br />KdSti L HunZlker <br />INSURER C: <br />3204 Summitview Ave <br />Yakima, WA98902 <br />INSURER O: <br />INSURER E: <br />1INSURERF. <br />(Ea. Occurrence) <br />MED UP (Any one$ <br />persory <br />CLAMS MADE El OCCUR <br />CUSTOMER ID: 3TDIS92QX CERTIFICATE NUMBER: P-IND3TDI59KVQX-04 REVISION NUMBER: 00 <br />THIS ISTD CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTOTHE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY <br />REQUIREMENT, TERM OR CONDITION OFANYCONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE <br />POLICIES DESCRIBED HEREIN IS SUBJECT -TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, <br />INSR <br />TYPEOFINSURANCE <br />ADEL <br />SUER <br />POLICY NUMBER <br />POUCY <br />POUCY <br />OMITS <br />LTR <br />INSR <br />VAR <br />EFF <br />EXP <br />GENERAL LIABILITY <br />EACH OCCURRENCE $ <br />DAMAGE TO RENTED PREMISES $ <br />COMMERCIAL GENERAL LIABILITY <br />(Ea. Occurrence) <br />MED UP (Any one$ <br />persory <br />CLAMS MADE El OCCUR <br />PERSONAL&AOVINIUPY $ <br />EPLI-CWMSAWDE <br />GENERAL AGGREGATE $ <br />PRODUCTS{OMP/OPAGG $ <br />EPLI-OCCUR <br />EN'L AGGREWTE LIMIT APPLIES PER <br />8 <br />POLICY PROTECT LOC <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE OMIT $ <br />ANY AUTO <br />Ta accitlenl <br />BODILY INJURY (Per person) $ <br />ALL OWNED SCHEDULED <br />BODILY INJURY (Per accident) $ <br />ACT QS AllT05 <br />PROPERTY DAMAGE $ <br />t <br />HIRED AUTOS NON -OWNED <br />UMBRELLA OCCUR <br />UAB <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />EXCESS UAB CLAIMS -MAD <br />E <br />DED RETENTION $ <br />WORKERS COMPENSATION <br />WCSTATUTORIUMRS OTHER <br />D EMPLOYERS' Y/N <br />EL. EACH AcaDENr $ <br />ANY PROPRIETOR/ PARTNER/ <br />EL.DISEASE EACHEMPLOYEE $ <br />EXECUTIVE OFFICER/ MEMBER <br />EXCLUDED? Ifyes, describe under <br />E1.DISEA9E PODCYLIMIT $ <br />(Mandatary In NH) Description of Operations <br />Professional Liability Insurance <br />Per Claim Limit $1,000,000.00 <br />A <br />Retroactive Date: 03-O8-2017 <br />Y <br />N <br />P-IND3TDIS9KVQX-04 <br />03/08/2021 <br />03/08/2022 <br />Aggregate Limit $3,000,000.00 <br />State Licensing Board Limits $35,000.00 <br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks schedule, may be attached ifmore space is required) <br />CERTIFICATE HOLDER <br />CANCELLATION <br />Kittitas Countyjuvenile Court Services <br />SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />205 W 5th Ave <br />DATE THEREOF, NOTICE WILL BE DELIVERED ON ACCORDANCE WITH POLICY PROVISIONS, <br />Ellensburg WA 98926-2890 <br />AUTHORIZED <br />REPRESENTATIVE /y�'J,JAan <br />ACORD 25 (2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. <br />The ACORO name and logo are registered marks of ACORD <br />