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DATE (MMIDDlYYYY) <br />fccwa CERTIFICATE OF LIABILITY INSURANCE _ olr3orzozs <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 />CONTACT <br />PRODUCER yAME P res 1vaCcmrnnn_'+alL�n Custpme an A ent gm �n <br />PHONE FAX <br />Arrterican Underwriters 1 No.11 1 � 3A �87 <br />0429 S TACONIA WAY, TACOMA, WA 98409 EMAIL nrr pr siva.GOm <br />INSURER A; Uniiea =inarniai Casual Cmn a 117711 <br />INSURED INSURER B : <br />PEERS RISING INSURER C ; <br />110 W 6TH AVE PMB 118 INSURER D <br />ELLENSBURG, WA 98926 <br />INSURERE. - <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: 799354885194877319DO13026T204653 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 />ADDLISUB I POLICY EFF POLICY EXP <br />SR TYPE OF INSURANCE I INSD 1NV0 POLICY NUMBER �IMMIDONYYY1 (M.MID01YYYY), <br />fR I <br />[COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE ❑ OCCUR !+F <br />l <br />QEWL AGGREGATE 7 APPLIES PER: <br />POLICY L._J ject 7 LOC <br />Ty OTHER: <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />Oyyt,;rp �G�-i@OULED N N <br />A AUyTOS ONLY %� AUTOS <br />aIJT(S ONLY A4n3iNDS ONLV <br />UMBRELLA LIAB QUGUK <br />EXCESS LIAB CLAIMS -MADE <br />DEa RE7EN r:ON 3 <br />WORKERS CAMPE:NSATION YIN <br />I AND EMPLOYERS' LIABILITY <br />A.�rYPROPP.IETOcRJPFAxRTrinRlfiK ECUTIVE N I A <br />0021362990 1 10i i 3/2025 I 10113/2026 <br />LIMITS <br />i <br />EACH OCCURRENCEAM <br />G <br />A ws 3 Ee <br />MED E. ,An One rsen7 <br />PERSONAL &ADV INJURY <br />GENERALAGGREGATE <br />S <br />PRODIiCTS COAIP4P AGG <br />1lvGLE LIMTT <br />en <br />0 donly <br />S 1 7D0 <br />aaDILY iNJUr7Y Per man] <br />a <br />300ILY INJURY Per ace,deru <br />S <br />RTJ DAMAGE <br />fFer u4cminn1 <br />i <br />EACH OCCURRENCE <br />AGGREGATE <br />S <br />P H- <br />E.L. EACH .ACCIDENT <br />s <br />E.t_ DISEASE • EA 1,S OYE <br />E L DISEASE -POLICY LIMIT <br />$ <br />I [Man&uny In NMI <br />%I"crlbe under , <br />DESCF;II'VON OF OPERATIONS balmy S <br />JA <br />ACORD 101 for additional coverage details <br />002062990 <br />N N 1/113/2025 10i13l2025 <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />CERTIFICATE HOLDER CANCELLATION - <br />' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />PEERS RISING ACCORDANCE WITH THE POLICY PROVISIONS. <br />'I 10 W 6TH AVE PMB 1 I8 <br />ELLENSBURG, WA 98926 AUTHORIZED REPRESENTATIVE <br />- © 1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />