Laserfiche WebLink
--A,CORD SCHUPOF.Ol <br />CERTIFIGATE OF LIABILITY INSURANCE DATE (MM/ODTYYYY) <br />1126t2023 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYANDCONFERSNORIGHTSUPONTH <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGEBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUIREPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />E CERTIFICATE HOLDER. THIS <br />AFFORDED BY THE POLICIES <br />NG TNSURER(S),,AUTHORIZED <br />IM PORTANT:thelf certificate holder ants DITIAD AON INL SURED the havemust ADDITIONALpolicy(ies)lNs URED beor endorsed.provisions <br />ROGA NTto$SUB WAIVEIS thetoD,anterms conditiond ofs the ncertaisubject anpolicy endorsement.statemA onentrequiremaythisdoescertificateconfernotthertificateceinholderoflieusutochendorseme <br />CONTACT <br />NAME: <br />fJ3,NnE", e,o' (866) 275-3775 <br />E.MAIL <br />ADDRESS: <br />INSURER(S) AFFORDING COVERAGE <br />rNsuRER A , Scottsdale lnsurance Company <br />INSURER B; <br />INSURER C : <br />INSURER D : <br />INSURER E: <br />INSURER F: <br />f#, r.r"),(866) 21 5-5018 <br />INSURED <br />Richard Schuknecht dba. Schuknecht's P.O.F Potygraph <br />NAIC # <br />41297 <br />Service <br />4'13 N 2nd Street <br />Yakima, WA 98901 <br />PROOUC€R <br />PayneWest lnsurance - TAG <br />14900 SW Barrows Rd, Ste 202 <br />Beaverton, OR 97007 <br />TYPE OF INSURANCE POLICY NUMBER LIMITS <br />ISTHIS CERTITO THAFY THET POLICIES OF RANCEINSU TEDLIS LOWBE HAVE BEEN TOISSUED INSUREDTHE ABOVENAMED THEFOR PERIODPOLICYDICAINTED,TANDINNOTWITHS ANY TERMREQUIREMENT CONDITIONOR ANY.rF ORCONTRACT DOCUMENTOTHER RESPECTWITH WHTO TH cHERTIFICAMATEBEt55DMAORPERTAYININSURANTHECEAFFOBYRDEDPOLITHECIESDESCRIBEDtsHEREINTOSUBJECTALLTHETERMS,ANDEXCLUSIONS CONDITION SUCHOF ILPOL ES.SHOWNLIMITS YMA HAVE BEEN BYREDUCED CLAIMS,PAID <br />EACH OCCURRENCE $ <br />DAMAGE TO RENTED <br />PREMISES {Ea occurrence) $ <br />MED EXP {Any one person) $ <br />PERSONAL & ADV INJURY $ <br />GENEML AGGREGATE $ <br />PROOUCTS. COfuIP/OP AGG $ <br />2t4t2023x R8S0116568 <br />5, <br />5, <br />21412A24 <br />4,000, <br />1 00, <br />A X corurvrenctAL GENERAL LlABtLtry <br />clAilvts.tvtADE x OCCUR <br />GEN'L AGGREGATE LIfuIIT APPLIES PERX poucv tfl9i Loc <br />A AUToMoBTLE LrAsrLrry <br />ANY AUIO <br />OWNED SCHEOULEDAUTOSONLY AUTOSX Xl-flr%os orr" x lSiaBS,Eg <br />21412023 BoDtLy tNJURy (per person) <br />BODILY INJURY (Per accidenr) <br />PSOPERTY DAI\IAGE(Per accident) <br />1,000 <br />RBS0l 1 5643 214t2022 <br />UMSRELLA LIAB OCCUR <br />EXCESS LIAS CLAIfulS,fu1ADE <br />DED RETENTION$ <br />$ <br />$ <br />EACH OCCURRENCE <br />AGGREGATE <br />Y/N <br />N/A <br />WORKERS COMPENSATION <br />ANO EMPLOYERS' LIABILIIY <br />ANY PROPRIETOR,/PARTNERYEXECUTIVE <br />OFFICEFYMEMBER EXCLUDED?(Mandatory in NH) <br />lf describe E,L- DISEASE. EA EMPLOYEE S <br />STATUTE <br />E.L, EACH ACCIDENT <br />X <br />xA Errors & Omissions <br />rrors ons <br />2t412023 21412024 aggregateRBS01 1 6568 <br />1 6568 <br />LOCA TIONS VEH ICLES <br />al redtnsu attaper <br />(ACOR-O I 01, Add_ltional Remarks Schedule, may be atiached if more s pace is required)ched form GLS487 <br />Kittitas County <br />205 W sth Ave, Ste 105 <br />Ellensburg, WA 98926 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />@'1988-20,15 ACORD CORPORAT|ON. Alt rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />ACORD 25 (2016t03l,