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DATE (MM/DD/YYYY} <br />6t15t2021 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFIGATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BYTHEPOLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE 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.If SUBROGATION IS WAIVED <br />this certificate does not confer <br />, subject to the terms and conditions of the policy, certain <br />hts to the certificate holder in lieu of such e <br />may require an endorsement. A statement on <br />PRODUCER <br />Yakima Office <br />Paynewest lnsurance, lnc. <br />i t6t ir;rth iiiih nuii'ii,ii, -*'zoo <br />Yakima, WA 98902 <br />Kittitas County Health Network <br />400 E. Mountain View Ave c/o KVFR <br />Ellensburg, WA 98926 <br />INSURED <br />IIIQUBEB(s) AEf of, D!![9 qoVEEAGE <br />n lPhiladelpla lndemn ity hsUfaneelqm <br />Ann <br />INSURER B <br />c: <br />INSURER F <br />m <br />NAIC # <br />3-420885 FAX <br />(A/c, No); <br />,-A,CORD'\--' <br />KITTCOU-01 <br />CERTIFICATE OF LIABILITY INSURANCE <br />@ 1988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOWHAVEBEENISSUEDTOTHEINSUREDNAMEDABOVEFORTHEPOLICYPERIOD <br />INDICATED, NOTWTHSTANDING ANY REQUIREIVIENT, TERIV OR CONDITION OF ANY CONTRACTOROTHERDOCUMENTWTHRESPECTTOWHICHTHIS <br />CERTIFICATE MAY BE ISSUED OR IVAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREINISSUBJECTTOALLTHETERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIIVITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />TYPE OF INSURANCE POLICY NUMBER LIMITS <br />l <br />COMMERCIAL GENERAL LIABILITY <br />cmrus-rr,rnoe i xl o""r* <br />I]eoucvi fS""r i I <br />OTHFR' <br />XA <br />X <br />I <br />I <br />PER: <br />LOC <br />1t8t2021 1t8t2022 <br />IViED EXP <br />$ <br />1,0 <br />1 <br />& ADV INJURY <br />one <br />A AUTOMOBILE LIABILITY <br />ANY AUTO <br />OWNED <br />AUTOS ONLY <br />HIRED <br />AUTOS ONLY <br />SCHEDULED <br />AUTOS <br />NON-OWNED <br />AUTOS ONLYx <br />PHPK2203234 1t8t2021 1t8t2022 <br />BODILY INJURY (Per accident) i S <br />PROPERTY DAMAGE I(Perecciqe!'tt) I $ <br />ls <br />1,000,000 <br />II UMBRELLA LIAB <br />RETENTION $ <br />l <br />I <br />EXCESS LIAB <br />DED <br />OCCUR <br />CLAIMS-IVIADE <br />OCCURRENCE <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED?(Mandatory in NH) <br />lf yes, describe under <br />DESCRIPIION OF OPERATIONS below <br />N/A <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD I 01, Additional Remarks Schedule, mav be aftached if more space is required)ln respects to Professional Services Agreemeni which commenced on April 26, 2O2'l'lor COVID-19 Vaicine Outrea6h Community Health Worker. Additional <br />lnsured means the Kittitas County, its successors and assigns and the respective directors, officers, employees and agents. <br />Kittitas Gounty <br />205 West Sth Avenue, Suite 108 <br />Ellensburg, WA 98926 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />Q*l* 6,,i// <br />ACORD 25 (2016/03)