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OATE (MMIDD/YYYY) <br />t0/09/2023 <br />THIS CERTIFICATE lS ISSUED AS A MATTER OF INFORMATION ONLY /AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE <br />AFFORDED BY THE POLIC]ES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE <br />ISSUING INSURER(S), AUTHORIZED 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 <br />be endorsed. lf SUBROGATION lS WAIVED, subject to the terms and conditions of the policy, certain policies may require an <br />endorsement, A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />Trust Risk Management Services, Inc. <br />1791 Paysphere Circle <br />Chicago, [L60674 <br />CONTACI <br />NAME: Trust Risk Manaqement Services. lnc <br />PHONE <br />{A/C. No. Ext): 877.637.9700 <br />FAX <br />(A/c. No): 877.251.511 1 <br />EMAIL <br />ADDRESS: info@trustrms.com <br />INSURER(SI AFFORDING COVERAGE NAIC # <br />INSURER A: ACE American lnsurance Gompanv 22667 <br />INSURED <br />Dr. Monica Pilarc <br />Po Box 918 <br />Seabeck, WA 98380-0918 <br />INSURER B: <br />INSTIRER C: <br />INSURER D: <br />INSI.JRER E: <br />INSTJRER F: <br />.,4ACORif CERTIFICATE OF LIABILITY INSURANCE <br />COVERAGES CERTIFICATE NUMBER REVISION NUMBER: <br />CANC <br />Kittitas County Sheriff's Office <br />Ellensburg, WA <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED <br />BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE <br />DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />@ 1988-2015ACORD 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 BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY <br />PERIOD INDICATED. NOTWITHSIANDING ANY REQUIREMENT, TERI\i1 OR CONDITION OF ANY CONTRACT OR OTHER DOCUNIENT WITH RESPECT <br />TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT <br />TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR TYPE OF INSURANCE INSR <br />SUUf <br />wvD POLICY NUMBER <br />tsQLICY EIT <br />(MM/DDTYYYY} <br />PgLIUI EAP <br />(MM/DD/YYYN LIMITS <br />EACH OCCURRENCE s <br />OAMAGE TO RENTEO <br />PRFf\4lSES (Ei occrirrencP) <br />s <br />MED EXP (Any one person)$ <br />PERSONAL & ADV INJURY <br />5 <br />GFNFRAI AGGIIFGATF $ <br />PRODUCTS.COMPiOP AGG <br />s <br />GEN'L AGGREGAIE LIfuIIT APPLIES PER: <br />GENERAL LIABILITY <br />CLAIMS MADE OCCUR <br />PRO- <br />CONIBINED SINGLE LIMIT <br />aEe adidentl <br />s <br />BODILY INJURY (Per Person)s <br />BODILY INJURY (Per a€idenl <br />g <br />PROPERIY DAMAGE <br />(Per adcidenll <br />5 <br />AUTOMOBILE LIABILITY <br />AUIO <br />SCHEDULED <br />AUTOS <br />NON-OWNED <br />AUTOS <br />ALL OWNED <br />AUTOS <br />HIRED AUTOS <br />$ <br />EACH OCCURRENCEUMBRELLA LIAB <br />EXCESS LIAB <br />OCCUR <br />CLAIMS.MADE AGGREGATE g <br />DED RETENTION S <br />5 <br />PER <br />STATUTE <br />ofH- <br />ER <br />WORKERS COMPENSATION <br />AND EMPLOYERS LIASILITY <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICERiMEMBER EXCLUDED? <br />(Mandatory in NH) <br />lf yes. descibe under <br />DESCRIPTION OF OPERATIONS below <br />Y/N <br />IJ N/A <br />E-1. DISEASE . POLICY LIMI'I $ <br />58G22353445 06/07/2023 06/07/2024 Each lncident <br />Annual <br />Aooreoate <br />$ 1,000,000 <br />$3,000,000A <br />Psychologist's Professional Liability <br />Retroactive Date 06/O7 /2002 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORO 101, Additional Remarks Schedule, may be atlached if more space is required) <br />ACORD 25 (2016/03)