Laserfiche WebLink
CERTIFICATE OF LIABILITY INSURANCE <br />�� <br />DATE( rr' <br />49/2266/0018016 <br />THIS CERTIFICATE IS ISSUED ASA 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 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 pollcy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder In Ileu of such endorsement(s). <br />PRODUCER <br />Rothert Insurance <br />c/o Lael Insurance and Financial Svs. <br />2301 W Dolarway Road Suite 5 <br />Ellensburg WA 98926 <br />NAME: <br />PHON o E nlc•NO; <br />ADDRESS - <br />INSURER(S) AFFORDING COVERAGE NAIL 0 <br />INSURERA: Capitol Specialty Insurance Co 10328 <br />INSURED <br />Hilary Huffman <br />DBA: Huffman Farms <br />444 Buckboard Lane <br />Ellensburg WA 98916 <br />INSURERS. <br />INSURERC: <br />INSURERD <br />INSURERE <br />INSURERF: <br />r ^%f=oAr_=c r -=0 -my -A -M milly! 3KR• REVISION NUMBER: <br />V 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 CONTRACTOR OTHER DOCUMENT WITH RESPECTTO 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 LIM ITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />LTRTYPE <br />OF INSURANCE <br />RlWVDI <br />POLICY NUMBER <br />MMIDDNYYYl <br />MrDD1YYYY <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE 1.000.440 <br />' 1E 100,000 <br />PREbAfSES Ea a cramenCe <br />X 1 4NIMERCK GFNERPIL"ILITY <br />MED EXP (Any onapamonj $ 5,000 <br />CLAIMS -MADE n OCCUR <br />PERgONAL $ADV INJIRY 1,000,000 <br />A <br />Y <br />CS18006159-01 <br />09/29/2018 <br />11/04/2018 <br />GENERAL AGGREGATE $ 2.000.000 <br />GEN'I.AOGREGATELIMITAFf'LIESPER <br />PRODUCTS - COMP/OPAGG $ Included <br />$ <br />PRO- <br />P•oucir <br />AUTOMOBILE LIABILITY <br />COMOIN ' INC;LE LIM <br />E3 acuiderill <br />BODILY INJURY (Per person) $ <br />ANY AUTO <br />BODILY INJURY (Per accident) $ <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />NON -OWNED <br />HIREDAUTOS AUTOS <br />PROP _ TY RF] SCE <br />Por � Adm $ <br />UMBRELLA LIABOCCUR <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED I I RETENTION <br />$ <br />WORKERS COMPENSATION <br />WC STATU-OTH- <br />r o <br />AND EMPLOYERS' LIABILITY YIN <br />ANYPROP RIEfOR/PARTNER/EXECUTIVE --I <br />E L EACH ACCIDENT <br />E L DISEASE - EA EMPLOYE <br />OFFICERIMEMBER EXCLUDED? <br />(Mandatory In NH) <br />N 1A <br />E L DISEASE - POLICY LIMIT <br />If yes, dasc+k a under <br />DESCRIPTION OF OPERATIONS below <br />DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) <br />THIS CONTRACT IS REGISTERED AND DELIVERED AS A SURPLUS LINE COVERAGE UNDER THE INSURANCE CODE OF THE STATE OF <br />WASHINGTON, TITLE 48 RCW IT IS NOT PROTECTED BY ANY WASHINGTON STATE GUARANTY ASSOCIATION LAW. <br />RON ROTHERT INSURANCE, INC. / <br />Pumpkin Patch, Hay Rides, Pony Hops & Petting Zoo <br />Kittitas County, it's agents, officers, employees and assigns are added as an additional insured. <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Kittitas County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />205 W 5th Ave ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />Ellensburg WA 98926 <br />m 1988-ZUIUACUKU GUKPUKAIIUN. All rlgn[S reserVea. <br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD <br />