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DATE (MM/DD/Y\ryY) <br />07/22/2021 <br />THIS CERTIFICATE 15 I55UED A5 A N,IATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT <br />AFFIRMATIVELY OR NEGATIVELYAIV1END, EXTEND OR ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW THIS CERTIFICATE OF INSUMNCE DOES NOT <br />CONSTITUTE A CONTMCI BENVEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCE& AND THE CERTIFICATE HOLDER. <br />IMPORTANT: lf the certlflcate holder ls an ADDITIONAL INSURED, the pollcy{les) must be endorsed. lf SUBROGATION lS WAIVED, subject to the terms and condltlons ofthe <br />pollcy, certain pollcles may requlre endorsement. A statement on thls certlflcate does not confer rights to the certl{icate holder ln lleu ofsuch endorsements. <br />PRODUCER <br />NASW RRG Plan Administrator <br />1 200 East Glen Avenue <br />Peoria Heights, lL 6'l 616-5348 <br />CONIACT <br />NAME: <br />PHONE FAX <br />E-MAIL <br />ADDRESS: <br />INSURER(S) AFFORDING COVERAGE NAI' # <br />INSU RED <br />Kristi L Hunziker <br />3204 SummitviewAve <br />Yakima, WA 98902 <br />INSURERA: NASW Risk Retention GrouD 1 4166 <br />INSIIRER B: <br />INSURER C <br />NSURER D: <br />NSURER E: <br />NSURER F: <br />CUSTOMER lD: 3TD|S9 <br />CERTIFI OF LIABI N <br />CERTIFICATE NUMBER: G REVISION NUMBER: O0 <br />O 1988"2010 ACORD CORPORATION. Alt rights re$erved. <br />The ACORO name and logo are registered marks sf ACORD <br />2 <br />THIS IS TO CERTIF/ THAT THE POLICIES OF INSUMNCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY <br />REQUIREMENI TERN,1 OR CONDITION OF ANY CONTRACI OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTI FICATE I\IAY BE ISSUED OR IVAY PERTAIN, THE INSURANCE AFFORDED BY THE <br />POLICIES DESCRIBED HEREIN IS SUB.IECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIM ITS SHOWN N,4AY HAVE BEEN REDUCED BY PAID CLAIMS, <br />INSR <br />LTR <br />TYPE OF INSURANCE ADDL <br />INSR <br />sUBR POLICY NUMBER POLICY <br />EFF <br />POLICY <br />EXP <br />LttiltTS <br />EACH OCCURRFN'F $1,000,000.00$ <br />DAMAGE TO RENTED PRE[IISES <br />(Ea. Occurrence) <br />$ <br />MED EXP (Anyone oerson)$ <br />PERSONAL & ADV INIIJRY $ <br />GFNFRAI AGGRFGATF $ 53,000,000.00 <br />PRODIIffS COMP/OPAGG $ <br />A <br />til:lT-i'Ti;:l,T'. n,.. <br />GENEML TIABILITY <br />OCCUR <br />LtABil tilGENEML <br />CLAlIVS MADE <br />EPLI, CLAIMS MADE <br />EPLI , OCCUR <br />Y N G.45145HG541.A2 07/16/2021 0t /16/2022 <br />$ <br />COMBINED SINGLE LIIIIT <br />(Ea accidenu <br />$ <br />BODILY INIURY(Per person)$ <br />BODILY lNl{JRY (Per accident)$ <br />AUTOIVOBILE LIABILIry-lo*uorrn <br />J <br />lAr r owNFDJeuros <br />ln,*uo orro, <br />SCHEDULED <br />NON-OWNED PROPERry DAMAGE $ <br />FA'H OCCI IRRFN'F $ <br />AGGREGATE $ <br />DED <br />CLAIN,4S-MAD <br />$ <br />$ <br />WC STATUTORY LIMITS lornu* <br />€.1. EACH ACCIDENT $ <br />E-1. DISEASE EACH EIVPLOYEE $ <br />E,L, DISEASE - POLICY LIMIT $ <br />WORKERS COI\,lPENSATION <br />AND EIVlPLOYERS' <br />ANY PROPRiETOR/ PARTNER/ <br />EXFCUTIVE OFFICER/ MEMBER <br />lfyes, describe under <br />Description of Operations(Mandatory in NH) <br />Y/N <br />EXCLLJDFD? <br />DESCRIPTION OF OPEMTIONS / LOCATIONS / VEHICLES (ACORD 1 01, Additional Remarks Schedule, may be attached if more space is required) <br />:ANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, NOTICE WILL BE DELIVERED ON ACCORDANCE WTH POLICY PROVISIONS. <br />CERTIFICATE HOLDFR <br />Kittitas County Juveni le Court Services <br />205 W 5th Ave <br />Ellensbu rg WA 98926-2890 <br />tun € P-.€AUTHORIZED <br />REPRESENTATIVE <br />ACoRD 25 (2010/05)