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Crime Stoppers Application & Ins.
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04. April
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2023-04-04 10:00 AM - Commissioners' Agenda
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Crime Stoppers Application & Ins.
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Last modified
3/30/2023 12:10:02 PM
Creation date
3/30/2023 12:09:17 PM
Metadata
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Template:
Meeting
Date
4/4/2023
Meeting title
Commissioners' Agenda
Location
Commissioners' Auditorium
Address
205 West 5th Room 109 - Ellensburg
Meeting type
Regular
Meeting document type
Supporting documentation
Supplemental fields
Item
Request to Approve Yakima County Crime Stoppers Special Event Application - Your Canyon for a Day to be held on May 21, 2023
Order
2
Placement
Consent Agenda
Row ID
101486
Type
Special Event Application
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CERTIFICATE OF LIABILITY INSURANGE DATE (MM/DD/YYYY} <br />o1t24t2023 <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 COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF TNSURANCE 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 ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br />lf SUBROGATION lS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />StateFarm Bruce Sears <br />105 South 1st Street&, <br />Selah wA 989420669 <br />CONTACT <br />NAME:Bruce Sears <br />509-697-4900 <br />bruce.sears.com <br />INSURER(S} AFFORDING COVERAGE NAIC # <br />rNsuRER A : State Farm Fire and Casualty Company (Auto or Fire)25143 <br />INSURED <br />CRIME STOPPERS OF YAKIMA COUNTY INC <br />PO BOX 1 1056 <br />YAKIMA wA 989092056 <br />INSURER B <br />INSURER C : <br />INSURER D <br />INSURER E ; <br />INSURER F <br />COVERAGES NUMBER:REVISION NI,JMBER: <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. 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 INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHO\^N MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSK <br />tfR TYPE OF INSURANCE <br />ADD <br />INSD <br />-ub <br />WVD POLICY NUMBER <br />tsULIUY EFF <br />TMM/ND/YYvvI <br />tsULIUY EIts <br />IMM'DNryYYYI LIMITS <br />EACH OCCURRENCE s 2,000,000 <br />DAMAGE TO RENTED <br />PRFMISFS /Fa nen' 'rrFn.al s 300,000 <br />MED EXP (Any one person)E 5,000 <br />PERSONAL & ADV INJURY $ <br />GENERAL AGGREGATE s 4,000,000 <br />PRODUCTS - COIV]P/OP AGG E 4,000,000 <br />A <br />COMMERCIAL GENERAL LIABILITY <br />X <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />CLAIMS-MADE OCCUR <br />LOCPOLICY <br />OTHER: <br />PRO- <br />JECT <br />Y N 98-BJ-G478-3 07t01t2022 07101t2023 <br />$ <br />s <br />BODILY INJURY (Per person)$ <br />BODILY INJURY (Per accident)$ <br />TKUTEK I Y UAIVIAbE <br />lPer accidenl)$ <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />OWNED <br />AUTOS ONLY <br />HIRED <br />AUTOS ONLY <br />SCHEDULED <br />AUTOS <br />NON-O\^JNED <br />AUTOS ONLY <br />s <br />EACH OCCURRENCE $UMBRELLA LIAB <br />EXCESS LIAB <br />OCCUR <br />CLAIMS-MADE AGGREGATE $ <br />DED RETENTION $$ <br />PER OTH- <br />$ <br />E,L, EACH ACCIDENT $ <br />E.L. DISEASE - EA EMPLOYEE $ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRI ETOR/PARTNER/EXECUTIVE <br />OFFICERYMEMBER EXCLUDED? <br />(Mandatory in NH) <br />lf yes, describe under <br />DFSCRIPTION OF OPFRATIONS helow <br />Y/N <br />N/A <br />E,L. DISEASE - POLICY LIMIT $ <br />DESCRIPTIONOFOPERATIONS/LOCATIONS/VEHICLES (ACORDl0l,Additional RemarksSchedule,m.ybeattachedifmorespaceisrequired) <br />LOCATION: 128 N 2ND ST, YAKIMA, WA 98901 <br />YOUR CANNYON FOR A DAY RIDE <br />ADDITIONAL INSURED - CERTIFICATE HOLDER: KITTITAS COUNTY, WASHINGTON STATE PATROL, DEPT OF TRANSPORTATION, BUREAU OF <br />LAND MANAGEMENT, US GOVERNMENT AND "The United States Department of the lnterior-BLM, WSDOT 2809 Rudkin Rd, Union Gap, WA 98903 is <br />additionally insured." <br />CANCELLA <br />@ 1988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />1001486 2005 155279 205 01-'t9-2023 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVEREO IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />ELLENSBURG wA 98926 <br />KITTITAS COUNTY <br />205 W 5TH STE .I08 <br />AUTHORIZED REPRESENTATIVE <br />R. 4/J*_, <br />This form was system-generated on 0112412023 <br />ACORD 25 (2016/03)
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