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<br />coNccoN-01
<br />CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
<br />11t30t2022
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVEMGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSUMNCE DOES NOT CONSTTTUTE A CONTRACT BETWEEN THE |SSU|NG TNSURER(S), AUTHORTZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: lf the certificate holder is an ADDITTONAL |NSURED, the pot
<br />lf SUBROGATION lS WAIVED, subject to the termsandconditionsof the
<br />this certificate does not confer rights to the certificate holder in lieu of such
<br />icy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />policy, certain policies may require an endorsement. A statement on
<br />endorsement(s).
<br />PRODUCER
<br />Hub lnternational Northwest LLC
<br />PO Box 3018
<br />Bothell, WA 98041
<br />CONTACT
<br />NAME:
<br />f#8,tfi ,,,,,, (425) 4g945oo 485-8489
<br />now ubinternational.com
<br />INSURERTS} AFFORDING COVERAGE NAIC #
<br />TNSURERA :Alaska National lnsurance Comoanv 38733
<br />INSURED
<br />Concord Gonstruction lnc.
<br />8557 Lateral B Road
<br />Wapato, WA 98951-9732
<br />INSURER B
<br />INSURER C :
<br />INSURER D
<br />INSURER E :
<br />INSURER F :
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOWHAVEBEENISSUEDTOTHEINSUREDNAMEDABOVEFORTHEPOLICYPERIOD
<br />INDICATED. NOTWTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSUMNCE AFFORDED BY THE POLICIES DESCRIBED HEREINISSUBJECTTOALLTHETERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHO\AN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSRITP TYPE OF INSURANCE ADDttNsn POLICY NUMBER POLICY EFFIMM/NNMYY!POLICY EXPIMM/nnnwr LIMITS
<br />EACH OCCI
<br />'RRFNCF
<br />1,000,000$
<br />DAMAGE TO RENTED
<br />PRFMISFS lFa occr rrrpnnel 100,000
<br />MFD FXP /Anv one oersonl 5,000$
<br />PERSONAL & ADV INJURY 1,000,000$
<br />GFNFRAI AGGRFGATF 2,000,000$
<br />PRODUCTS - COMP/OP AGG 2,000,000s
<br />A COMMERCIAL GENER,AL LIABILITY
<br />x
<br />LIMIT
<br />POLICY PRO-JECT
<br />X
<br />X WA STOP GAP
<br />CLAIMS-MADE OCCUR
<br />PER:
<br />LOC
<br />X X 22D PS 31513 413t2022 413t2023
<br />WA STOP GAP EL 1,000,000$
<br />COMBINED SINGLE LIMITfFa acci.lpnf)1,000,000s
<br />BODII Y lN.ll IRY lPcr narannl $
<br />BODILY INJURY lPer accident)s
<br />$
<br />A AUTOMOBILE LIABILITY
<br />SCHEDULED
<br />AUTOS
<br />NON.O!\NED
<br />AUTOS ONLY
<br />Coll $500
<br />X
<br />X X
<br />HIREDAUTOS ONLY
<br />Comp $250
<br />ANY AUTO
<br />O\A/NED
<br />AUTOS ONLY
<br />X X 22D AS 31613 4t3t2022 4t3t2023
<br />s
<br />X X FACH OCCI IRRFNCF 5,000,000$UMBRELLA LIAB
<br />EXCESS LIAB
<br />OCCUR
<br />CLAIMS.MADE AGGREGATE 5,000,000s
<br />A
<br />DED x RETENIqN $ 1 0,000
<br />22D LU 31613 4t3t2022 4t3t2023
<br />$
<br />PER
<br />STATI ITF x OTH.
<br />FR
<br />E.L. EACH ACCIDENT 1,000,000
<br />E L DISFASF - FA FMPI OYFF 1,000,000$
<br />A WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRI ETOR/PARTNER/EXECUTIVE
<br />OFFICER/i'EM BER EXCLUDED?(Mandatory in NH)
<br />lf yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />N/A
<br />22D PS 31613 4t3t2022 4t3t2023
<br />E.L. DISEASE - POLICY LIMIT 1,000,000$
<br />DESCRIPTIONOFOPERATIONS/LOCATIONS/.VEHICLES (ACORDlOl,AdditionalRemarksschedule,maybeattachedifmorespaceisrequired)
<br />Re: Kittitas County Bloom Pavilion Additions.
<br />Kiftitas County is included as an Additional lnsured, coverage is Primary and non-contributory and Waiver of Subrogation applies per the aftachedforms/endorsements. Per Project Aggregate applies to General Liability policy, per attached form/endorsement.
<br />Kittitas County
<br />205 WSth Avenue,Suite 108
<br />Ellensburg, WA 98926
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />er n+,
<br />@ 1988-2015 ACORD CORPORATION. Alt rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />ACORD 25 (2016t031
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