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-_-.,.'qA"(:(1Rr'jo CERTIFICATE OF LIABILITY INSURANCE <br />CERTIFICATE NUMBER N NUMBER <br />CAN <br />@ 1988-2015 ACORD CORPORATTON. Ail rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />COVER.AGES <br />onre lunloolwvv; <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. <br />THIS CERTIFICATE DOES NOTAFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE <br />POLICIES BELOW. THIS CERTIFICATE OF INSU <br />AUTHORIZED REPRESENTATIVE OR PRODUCE <br />RANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), <br />R, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDI <br />subject to the terms and conditions of the policy, <br />TIONAL INSURED, the <br />certain policies may req <br />policy(ies) must be endorsed. tf SUBROGATTONTS WAIVED, <br />uire 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 />NUTMEG INS AGENCY INC/PHS <br />76210781 <br />The Hartford Business Service Center <br />3600 Wseman Blvd <br />San Antonio, TX78251 <br />CONTACT <br />NAME: <br />PHONE (888) 925-3137 <br />(A/C, No, Ext): <br />FAX <br />(A/C, No): <br />E-MAIL <br />ADDRESS: <br />INSURER(S} AFFORDING COVERAGE NAIC# <br />INSURED <br />LEPS-PSS PLLC DBA Public Safety Psychological <br />2081844TH AVE WSTE 150 <br />LYNNWOOD WA 98036.7734 <br />Sentinel lnsurance Company LtdINSURER A :1 1000 <br />INSURER B <br />Hartford lnsurance Company of the <br />Southeast <br />3826'1 <br />INSURER C <br />INSURER D <br />INSURER E : <br />INSURER F : <br />MAY MAY PERTAIN, <br />ISTH TOIS EU FYRTI THETHAT cPOLI ES Fo EINSURANC STEDLI LOWBE BEENHAVE TOISSUED ETH NAMEDINSURED FORABOVE POTHE PERIODLICY <br />ICAIND ANITtrN NINT\ATTHqT ANIVntNln a Utrn <br />^tT <br />PtrfiTtr TtrAN'R ht lTt F U I ntoTCERtFtTEBESSUEDORINSUTHEERANCEDAFFORDTHBYPOECILIDESRIESCHERBEDEISNUECTBJTOTHEALL <br />EXCLUSIONTERIVIS ANDS NSCONDITIO SUCOF POLIH ct ES TCLIMI HOWN YMA BEENHAVE EDR CEU BYD CLAIPAID MS. <br />TYPE OF INSURANCE POLICY NUIVIEER LIMITS <br />EACH OCCURRENCE <br />$1,000,000 <br />X <br />CO[/MERCIAL GENERAL LIABILITY <br />General Liability MED EXP (Any one person)$10,000 <br />PERSONAL &$2,000,000 <br />GENERAL AGGREGATE $4,000,000 <br />PRODUCTS - COMP/OP AGG $4,000,000 <br />A <br />X <br />GEN'L AGGREGAIE LI[4IT APPLIES PER: <br />LOCPOLICY <br />OTHER: <br />PRO. <br />JECT <br />X 76 SBU BF0017 05t21t2022 o5t21t2023 <br />BODILY INJURY (Per person) <br />BODILY INJURY (Per accident) <br />RTY <br />A <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />ALL OWNED <br />AUTOS <br />HIRED <br />AUIOS <br />SCHEDULED <br />AUIOS <br />NON-OWNED <br />AUTOS <br />76 SBU BFOO17 05t21t2022 05121t2023 <br />X EACH OCCURRENCE $1UMBRELLA LIAB <br />EXCESS LIAB CLAIMS. <br />MADE AGGREGATE $1A <br />$ 10,000 <br />76 SBU BFOO17 05t21t2022 0512112023 <br />X <br />E-1. EACH ACCIDENT $100,000 <br />E.L. DISEASE -EA EMPLOYEE $100,000 <br />B <br />AND EMPLOYERS' LIABILIW <br />ANY <br />PROPRIETOR/PARTNER/FXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />lf yes, describe under <br />N/A 76 WEG AKOLBB 0111212023 0111212024 <br />E,L. DISEASE - POLICY LIIVIIT $500,000 <br />A EMPLOYMENT PRACTICES <br />LIABILIry 76 SBU 8F0017 0512112022 05t21t2023 Each Claim Limit <br />Aggregate Limit <br />$10,000 <br />$10 <br />OF OPERATIONS / LOCATIONS / VEHTCLES (ACORD lOl, Addirionat Remarks Schedule, may be attached if more space is required) <br />red'soseThlousualthensu Noticeons of Cancel onlati wil be tndedOperati withaccordance SSForm attachedprovi1223,thisto ISCoveragpolicy <br />nonand Businessthe Liaprimarypercontributory Form 0008SS toattached thisbilityCoverage Ce hrtificate ISolder anpolicy additional dtnsure per <br />nessBusi L SForm attached thistoCoverages0008,icypol <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICI <br />BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED <br />IN ACCORDANCE WITH THE POLICY PROVISIONS. <br />BE CANCELLEDKittitas County <br />205 W sTH AVE STE 1 OB <br />ELLENSBURG WA 98926-2887 <br />lft a-a-r.f /azfr-.tA--t <br />AUTHORIZED REPRESENTATIVE <br />ACORD 25 (20't6t03)