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GELS&SM-01
<br />LWELCH
<br />ACL./Rf.J
<br />�,,,,,,,. CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MMroD1YYYY)
<br />10/7/2025
<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 endorsements .
<br />PRODUCER
<br />Terris, Lewis & Wilke Insurance, Inc.
<br />P.O. Box 1789
<br />Yakima, WA 98907
<br />C ACT
<br />PHONE ,Ext): (509) 248-3515 (A/CNo):(509) 248
<br />FAX, -3673
<br />- AI . corts@tlwins.com
<br />INSURE S AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A: Transportation Insurance Company
<br />20494
<br />INSURED
<br />INSURER B : American Casualty Company of Reading, PA
<br />20427
<br />INSURER C: Continental Insurance Company
<br />35289
<br />Belsaas & Smith Construction, Inc.
<br />INSURER D :
<br />P 0 Box 926
<br />Ellensburg, WA 98926
<br />INSURER E
<br />INSURER F :
<br />C-QVFRAGE-5 CFRTIFICATF NIIMRFR- 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 />INSR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXPLTR
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE o OCCUR
<br />4032762756
<br />9/1/2026
<br />9/1/2026
<br />DDRAMAGETO aEoNTEDn
<br />$ 100,000
<br />MED EXP (Any oneperson)
<br />$ 15,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY � jeT LOC
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />WA STOP GAP
<br />$ 1,000,000
<br />OTHER:
<br />B
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />$ 1,000,000
<br />BODILY INJURY Perperson)
<br />$
<br />X ANY AUTO
<br />4032762738
<br />9/112025
<br />9/1/2026
<br />BODILY INJURY Per accident
<br />$
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />SSWNEp
<br />AUTOS ONLY AUOTOS ONLY
<br />PPe�aERTYt AMAGE
<br />$
<br />$
<br />C
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />4032762741
<br />9/1/2025
<br />9/1/2026
<br />AGGREGATE
<br />$ 10,000,000
<br />DED I X I RETENTION $ 10,000
<br />$
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY
<br />FICER/M IIETOER EXCLUDED ECUTIVE ❑
<br />�iAandatary in NH)
<br />NIA
<br />PER ORH-
<br />E.L. EACH ACCIDENT
<br />---
<br />$
<br />E.L. DISEASE - EA EMPLOYEE
<br />$
<br />E.L. DISEASE - POLICY LIMIT
<br />$
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks SchedWe, may be attached If more space is required)
<br />Project: New regional search and rescue/eoc facility - 2021 Airport Road, Cie Elum WA 98922
<br />Kittitas County, its officials, employees and agents per written contract are named as additional insured, with waiver of subrogation and primary
<br />non-contributory per form CNA 74705XX 0115. Completed operations, per form CNA76079XX 0322
<br />Kittitas County
<br />205 W 5th Ave Suite 10
<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 />ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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