Laserfiche WebLink
AC, 0 <br />l._.--' CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MM/DDANVY) <br />07/22/2021 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT <br />AFFIRMATIVELY OR NEGATIVELYAMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT <br />CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the cerd&ace holder Is an ADDITIONAL INSURED, the pollcytles) must be endorsed. If SUBROGATION 15 WANED, subject to the terms and conditions ofthe <br />policy, certain policies may require endorsement. AStatement on this certlflcate does not confer rights to the certificate holder In lieu of such endorsemends. <br />PRODUCER <br />NASW RRG Plan Administrator <br />1200 East Glen Avenue <br />Peoria Heights, IL 61 61 6-5 348 <br />CONTACT <br />NAME' <br />PHONE <br />WC, Nn, EA). <br />FAX <br />wC NPE <br />E -MAL <br />ADDRESS: <br />INSURERS) AFFORDING COVERAGE NAIC# <br />INSURED <br />Knstl L HUnZlker <br />3204 Summitview Ave <br />Yakima, WA98902 <br />INSURERA: NASAL Risk Retention Group 14366 <br />INSURER B: <br />INSURER C <br />INSURERD: <br />N'UL R E. <br />'SURER F. <br />CUSTOMER ID: 3TDIS92CJX CERTIFICATE NUMBER: G45T45HGS4J-02 REVISION NUMBER: 00 <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAMED ABOVE WR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY <br />REQUIREMENT, TERM OR CONDITION OFANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BYTHE <br />POLICIES DESCRIBED HEREIN IS SUB)ECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />HER <br />TYPE OF INSURANCE <br />MDL <br />BUBB <br />POLICY NUMBER <br />POLICY <br />POLICY <br />LIMITS <br />LTR <br />INSR <br />W`D <br />EFF <br />EXP <br />GENERAL LIABILITY <br />EACH OCCURRENCE $ $t000.000.00 <br />DAMAGE TO REMED PREMISES $ <br />GENERAL UABILITY <br />(Ea. OccureNP) <br />MED EXP IAryone person) $ <br />1COMMERCIAL <br />CLAIMS MADE ®OCCUR <br />A <br />EPLI -CLAIMS MADE <br />Y <br />N <br />GA5T45H4 02 <br />GSf <br />07/16/2021 <br />07/16/2022 <br />PERSONALBADVINIURv $ <br />GENERK AG6REWTE E $3.000.000.00 <br />EPLI-OCCUR <br />PRODUCTS-COMP/OPAGG E <br />LIMRAPPLIES PER: <br />E <br />NEN'LAGGREGATE <br />POLICY DPROJECT LOC <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT E <br />A <br />ALLL LOWNE OWNED SCHEDULED <br />At AUTOS <br />TOS <br />tE accitlentt <br />BODILY INJURY (Per person) § <br />BODILY INJURY (Per accident) b <br />E E <br />PP11MGILI <br />(Per <br />HIRED AUTOS NON -OWNED <br />A. <br />M <br />UMBRELLAUAB OCCUR <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />EXCESS DAB CLAIMSMAO <br />DED RETEMION 8 <br />ORKERS COMPENSATION <br />WC STATUTORY LIMITS OTHER <br />O EMPLOYERS Y/N <br />ANY PROPRIETOR/ PARTNER/ <br />El <br />EL. EACH ACCIDENT Is <br />EL.BISEASE EACHEMPLOYEE g <br />EXECUTIVE OFFICER/ MEMBER <br />EL.DISEASE-POLICYLIMIT $ <br />EXCLUDED? Ifyes, describe under <br />(Mandatory in NH) Descriptim of Operations <br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additlonal Remarks Schedule, may be attached if more space is required) <br />CERTIFICATE HOLDER <br />CANCELLATION <br />Kittitas County Juvenile Court Services <br />SHOULD ANY OF THE 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 <br />ACORD 25 (2010/05) ©1988.2010 ACORD CORPORATION, All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />