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AC4 1 V CERTIFICATE OF LIABILITY INSURANCE <br />ATE (MM/DD/YYYY) <br />r11 /14/2024 <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: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS 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 endorsement(s). <br />PRODUCER <br />Hub International Northwest LLC <br />3125 Howe PI, Suite 201 <br />Bellingham WA 98226 <br />CONTACT <br />PHONE — FAX <br />)• 360 647-9000 IA1C, No): 360-734-8496 <br />ADORess: now.bellin haminfo hubinternational.com <br />_ INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />INSURER A: Western National Mutual Insurance Company <br />15377 <br />INSURED TENELCO-01 <br />INSURER B : <br />_ <br />Hartridge LLC dba Tenelco <br />2824 Old Hartford Rd <br />_ <br />INSURERC ____ <br />Lake Stevens WA 98258-9760 <br />INSURERD_ <br />INSURER E : <br />INSURER F <br />rnVFRAf_FC rPRTIFIrATF NIIMRFR• 11;R9R1;AA1 REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <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 INSURANCE 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 />ILT <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />SUBR <br />POLICY NUMBER I <br />MM/DDYIYYYY <br />MFF M DYE <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />Y <br />Y <br />CPP 122713504 <br />12/1/2024 <br />12/1/2025 <br />EACH OCCURRENCE _ <br />$1,000,000 <br />CLAIMS -MADE ® OCCUR <br />PREM SES EaDAMAGE Eoccurrence <br />$ 100,000 v <br />MED EXP (Any one person) <br />$ 5,000 <br />PERSONAL 8 ADV INJURY <br />$ 1,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$2,000,000 <br />PRODUCTS -COMP/OPAGG <br />$2,000,000 <br />POLICY � JECOT- LOC <br />$ <br />OTHER: <br />A <br />AUTOMOBILE LIABILITY <br />Y <br />Y <br />CPP122490104 <br />12/1/2024 <br />12/1/2025 <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$1,000,000 <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />BODILY INJURY (Per accident) <br />$ <br />OWNED X SCHEDULED <br />AUTOS ONLY AUTOS <br />X HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />_ <br />$ <br />A <br />X <br />UMBRELLA LIAB <br />X <br />OCCUR <br />UMB103845004 <br />12/1/2024 <br />1211/2025 <br />EACH OCCURRENCE <br />$1,000,000 <br />AGGREGATE _ <br />$ 1,000,000 <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED X RETENTION $ <br />$ <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />ANYPROPRIETOR/PARTNER/EXECUTIVE <br />CPP 122713504 <br />12/1/2024 <br />12/1/2025 <br />PER X OTH- <br />STATUTE ER <br />StOP G@R— _ <br />E.L. EACH ACCIDENT <br />$ 1,000,000 <br />---' -- -— <br />E.L. DISEASE - EA EMPLOYEE <br />$ 1,000,000 <br />OFFICER/MEMBEREXCLUDED? <br />(Mandatory in NH) <br />N / A <br />E.L. DISEASE - POLICY LIMIT <br />$ 1,000,000 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Per policy forms and conditions: Commercial General Liability Enhancement Endorsement form CG MU 0009 06 22; Additional Insured - Contractors - <br />Operations and Completed Operations - With Additional insured Requirement in Construction Contract form WN GL 139 06 18; Designated Construction <br />Projects (s) General Aggregate Limit form CIS 25 03 05 09; Designated Project (s) - Aggregate Limit; and Business Auto Enhancement Endorsement form WN <br />CA 80 06 19. Umbrella Liability follows form to terms and conditions of underlying policies. <br />CERTIFICATE HOLDER CANCELLATION <br />Kittitas County <br />205 W 5th Ave Ste 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 />atf ka41 <br />©1983-2015 ACORD COKPVKAI1UN. An ngnts reserveu. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />