Laserfiche WebLink
DATE (MM/DD/YYYY) <br />1'U28t2023 <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 INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <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 <br />PRODUCER <br />Hub lnternational Northwest LLC <br />1 10 Unity Street <br />Bellingham WA 98225 <br />ilJP\E^ .-.,. 360-647-9000 <br />INSURERTS) AFFORDING COVERAGE NAIC # <br />rNsuRER A: Western National Mutual lnsurance Company 15377 <br />INSURED <br />Hartridge LLC dba Tenelco <br />2824 Old Hartford Rd <br />Lake Stevens WA 98258-9760 <br />TENELCO-o1 INSTJRER B : <br />INSURER C : <br />INSURER D : <br />INSIIRER E : <br />INSTIRER F: <br />COVERAGES <br />GERTIFICATE OF LIABILITY INSURANCE <br />TE NUMBER:'1843038449 NUMBER: <br />@ 1988-2015 ACORD CORPORATION. All rights reserved <br />The ACORD name and logo are registered marks of ACORD <br />HOLDER <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSUMNCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />LIMITSPOLICY NlIMBER <br />POLICY EXP <br />rMM/DD/YYYYItsRTPTYPE OF INSURANCE <br />$ 1.000.000EACH OCCURRENCE <br />$ 100.000 <br />$ 5.000MED EXP (Anv one person) <br />$ 1.000.000PERSONAL & ADV INJURY <br />$ 2.000.000GENERALAGGREGATE <br />$ 2.000.000PRODUCTS . COMP/OP AGG <br />12t1t2024 <br />$ <br />Y Y cPP 122713504 12t1t2023COMMERCIAL GENERAL LIABILlrY <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />X <br />X <br />f__l pno-I IJECT I I <br />CLAIMS-MADE OCCUR <br />LOCXPOLICY <br />OTHER: <br />$ 1,000,000 <br />BODILY INJURY (Per person)$ <br />BODILY INJURY (Per accident)$ <br />$ <br />121112023 12t1t2024 <br />$ <br />X <br />X <br />X <br />AUTOMOBILE LIABILITY <br />SCHEDULED <br />AUTOS <br />NON-OWNED <br />AUTOS ONLY <br />ANYAUTO <br />OWNED <br />AUTOS ONLY <br />HIRED <br />AUTOS ONLY <br />Y cPP 122490104 <br />EACH OCCURRENCE $ 1.000,000XX <br />AGGREGATE $ 1.000.000 <br />OCCUR <br />CLAIMS-MADE <br />UMBRELLA LIAB <br />EXCESS LIAB <br />12t112023 121112024 <br />$nFn X RFTFNTION$r^^^^ <br />UMB 103845004 <br />(Ff;r,'tr lX OTH- <br />FR Sioo Gao <br />E.L. EACH ACCIDENT $ 1.000.000 <br />E.L. DISEASE - EA EIVPLOYEE $ 1.000,000 <br />'t2t1t2023 12t1t2024 <br />E.L. DISEASE - POLICY LIMIT $ 1,000,000 <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANYPROPRIETOFVPARTN ER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />lf yes, describe under <br />nFSCRIPTION OF OPFRATIONS below <br />Y/NE N/A <br />cPP 122713504 <br />DESCRIPTTON OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attachod if mor€ spaco is roquirsd) <br />Per oolicv forms and conditions: Commercial General Liabilitv Enhancement Endorsement form CG MU 0009 06 22; Additional lnsured - Contractors - <br />Ope'rations and Completed Operations - With Additional insuied Requirement in Construction Contract form WN GL 139 06 18; and Business Auto <br />Enhancement Endoriement fbrm WN CA 80 OO 19. Umbrella Liabiliiy follows form to terms and conditions of underlying policies. <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 />ffr'#f,,,,* <br />Kittitas County <br />205 W Sth Ave Ste 108 <br />Ellensburg WA 98926 <br />ACORD 25 (2016/03)