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A400RU® CERTIFICATE OF LIABILITY INSURANCE FDATE (MWDD/YYYY) 111 10/09/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Trust Risk management Services, Inc PHONE ( C, o, Ezt): 877.637.9700 FAX C.l : 877.251.5111 Trust Risk Management Services, Inc. 1791 Paysphere Circle AIL Chicago, IL 60674 ADDRESS: lnfo@trustnTis.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: ACE American insurance Company 22667 INSURED INSURER B: Dr. Monica Pilarc Po Box 918 INSURERC: Seabeck, WA 98380-0918 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD SUB POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MWDD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS MADE El DAMAGEDAMAGE TO RENTED PREMISES Ea occurrence) $ MED EXP (Any one person) S PERSONAL 8 ADV INJURY $ L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ M'OTHER: POLICY ❑JECOT_❑LOC PRODUCTS-COMP/OP AGG$ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per Person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident g HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS LIABILITY YIN SPER TATUTE I OTH- JER $ E.L.EACH ACCIDENT $ ANY PROPRIETORIPARTNER/EXECUTIVE n OFFICERWEMBER EXCLUDED? (Mandatory in NH) N / A E.L. DISEASE -EA EMPLOYE $ E.L. DISEASE -POLICY LIMIT $ If yes. describe under DESCRIPTION OF OPERATIONS below A Psychologist's Professional Liability Retroactive Date 06/07/2002 58G22353445 06/07/2023 06/07/2024 Each Incident Annual $1,000,000 $3,000,000 Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION Kittitas County Sheriffs Office Ellensburg, WA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD