Cert of Ins. and Dept feedback - Laserfiche WebLink

Home Browse Search

IICCWAY CERTIFICATE OF LIABILITY INSURANCE UAT/ Y) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 055/17/17/22016016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. It SUBROGATION 15 WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsetnent(s). PRODUCER CT NA}M1E Bdgdt Whltescarver _. For Service Call: _....._.............................. _ _ .. RHONE N _tn1iR.. a.>:xU-503-87Z�i8.4a................. �.f��.k 5�3_9Z79 Gales Creek Insurance Services a division of JD Fulwiler MAIL ADaREs,°s�_@VBDtSs� 5727 SW Macadam Ave IN$URtlit3}AFPOftf:M CO ERAGE tuAlca Portland, OR 97239 INSURgRA- StarrIndemni $LialsL _Comp by $ � INSURER B: INSURED Energy Events INSURER C : 10804 NW Oxbow Ridge Court INSURER D: Vancouver, WA 98685 A INSURER E : INSURER F: CUVtRAGES CERTIFICATE NUMBER: Rpvmi 1N Nl1MRPR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. !� tib TYPE OF INSURANCE Amt. POLICY NUMBER PC1L1 E FPOLTV�EXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X EACH OCCURRENCE $ 1 .000. 000 00 .. RENSEDSEB [Ea OLxu ren $ 300.000.00 MED EXP (Any one person) $ 5.000.00 1000108012 05/21/2016 05/01/2017 PERSONAL &ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: X I POLICY Q 7I LOC PRODUCTS- COMP/OP AGG $ $ AUTOMOBILE LIABILITY`y I•• j F {Ee sccidunit ( ] p Q0.00 .,E=n A ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS 1000108012 05/21/2016 05/01/2017 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ K — HIRED AUTOS X NON -OWNED PROPERTY pA $ -[Per aoddMl) $ j UMBRELLA LIABOCCUR .� � I EACH OCCURRENCE $ AGGREGATE $ 1 EXCESS LIAB CLAIMS -MADE DED t RETENTION $ I $ WORKERS COMPENSATION I ST�i� OTH- AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICE/MEMBER EXCLUDED? N 1 A IF E.L. EACH ACCIDENT $ [MaedetprYln NH) 1". 00201W under rJaCRiPTiON OF OPERATIO :9 h-1— E.L. DISEASE- EA EMPLOYE $ E.L DISEASE - POLICY LIMIT I S A �I LIQUOR LIABILITY ! x I 1000108012 05/21/2016 05/01/2017 Each Common Cause: $1,000,000.00 General Aggregate: $1,000,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) THE CERTIFICATE HOLDER IS ADDED AS AN ADDITIONAL INSURED BUT ONLY WITH RESPECT TO LIABILITY ARISING OUT OF OPERATIONS OF THE NAMED INSURED DURING THE POLICY PERIOD. Kittatas County 205 West 5th Ave., Ellensburg, WA 98926 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Brigitt Whitescarver f "/'rif � al4f4 Z ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD