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CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MM/DD/YYYY) <br />02/09/2023 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. <br />THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE <br />POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), <br />AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATIONIS WAIVED, <br />subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not <br />confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />CONTACT <br />NUTMEG INS AGENCY INC/PHS <br />NAME: <br />PHONE (888)925-3137 <br />(A/c, No, Ext): <br />FAX <br />(A/c, No): <br />76210781 <br />The Hartford Business Service Center <br />3600 Wiseman Blvd <br />E-MAIL <br />San Antonio, TX 78251 <br />ADDRESS: <br />INSURER(S) AFFORDING COVERAGE NAIC# <br />CLAIMS -MADE �OCCUR <br />X General Liability <br />INSURED <br />INSURER A: Sentinel Insurance Company Ltd. 11000 <br />LEPS-PSS PLLC DBA Public Safety Psychological <br />INSURER B: <br />20818 44TH AVE W STE 150 <br />DAMAGE TO RENTED $1,000,000 <br />PREMISES Ea occurrence <br />INSURERC: <br />LYNNWOOD WA 98036-7734 <br />INSURER D : <br />76 SBU BF0017 <br />INSURER E: <br />05/21/2023 <br />INSURER F : <br />COVERAGES CERTIFICATE NUMRER- RFVIRInIJ nlllnnRl=o• <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED.NOTWITHSTAN DING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE <br />TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />INSR <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />(MM/DDNYYYI <br />POLICY EXP <br />IMMIDDN YYY <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE $2,000,000 <br />CLAIMS -MADE �OCCUR <br />X General Liability <br />DAMAGE TO RENTED $1,000,000 <br />PREMISES Ea occurrence <br />MED EXP (Any one person) $10,000 <br />A <br />X <br />76 SBU BF0017 <br />05/21/2022 <br />05/21/2023 <br />PERSONAL SADV INJURY $2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE $4,000,000 <br />POLICY❑ PRO LOC <br />JECT <br />PRODUCTS - COMP/OPAGG $4,000,000 <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT $2000,000 <br />Ea accident <br />BODILY INJURY (Per person) <br />ANY AUTO <br />A <br />ALL OWNEDSCHEDULED <br />AUTOS AUTOS <br />76 SBU BF0017 <br />05/21/2022 <br />05/21/2023 <br />BODILY INJURY (Per accident) <br />X <br />HIRED NON -OWNED <br />AUTOS X AUTOS <br />PROPERTY DAMAGE <br />(Per accident) <br />UMBRELLA LIAB X <br />OCCUR <br />EACH OCCURRENCE $1,000,000 <br />A <br />EXCESS LIAB <br />CLAIMS - <br />MADE <br />76 SBU BF0017 <br />05/21/2022 <br />05/21/2023 <br />AGGREGATE $1,000,000 <br />DED X I RETENTION $ 10,000 <br />WORKERS COMPENSATION <br />PER OTH- <br />AND EMPLOYERS' LIABILITY <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />ANY YIN <br />PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />N/A <br />E.L. DISEASE -EA EMPLOYEE <br />(Mandatory in NH) <br />If yes, describe under <br />E.L. DISEASE - POLICY LIMIT <br />DESCRIPTION OF OPERATIONS below <br />A <br />EMPLOYMENT PRACTICES <br />LIABILITY <br />76 SBU BF0017 <br />05/21/2022 <br />05/21/2023 <br />Each Claim Limit $10,000 <br />Aggregate Limit $10,000 <br />DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Those usual to the Insured's Operations. Certificate holder is an additional insured per the Business Liability Coverage Form SS0008 attached to this <br />policy. Coverage is primary and noncontributory per the Business Liability Coverage Form SS0008, attached to this policy. Notice of Cancellation will be <br />provided in accordance with Form SS1223, attached to this policy. <br />CFKTIFICCTF HUIII nFR f`AlJ/`CI 1 ATIf%KI <br />Kittitas County <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED <br />205 West 5th Avenue Suite 108 <br />BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED <br />Ellensburg WA 98926 <br />IN ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />©1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />