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DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE
<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 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 lieu of such endorsement(s).
<br />CONTACTPRODUCERNAME:
<br />FAXPHONE
<br />(A/C, No):(A/C, No, Ext):
<br />E-MAIL
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />INSURER A :
<br />INSURED INSURER B :
<br />INSURER C :
<br />INSURER D :
<br />INSURER E :
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: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 />ADDL SUBRINSR POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITSPOLICY NUMBERLTR (MM/DD/YYYY)(MM/DD/YYYY)INSD WVD
<br />COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
<br />DAMAGE TO RENTED
<br />CLAIMS-MADE OCCUR $PREMISES (Ea occurrence)
<br />MED EXP (Any one person)$
<br />PERSONAL & ADV INJURY $
<br />GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $
<br />PRO-POLICY LOC PRODUCTS - COMP/OP AGG $JECT
<br />$OTHER:
<br />COMBINED SINGLE LIMITAUTOMOBILE LIABILITY $(Ea accident)
<br />BODILY INJURY (Per person)$ANY AUTO
<br />ALL OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS AUTOS
<br />NON-OWNED PROPERTY DAMAGE $HIRED AUTOS (Per accident)AUTOS
<br />$
<br />UMBRELLA LIAB EACH OCCURRENCE $OCCUR
<br />EXCESS LIAB CLAIMS-MADE AGGREGATE $
<br />$DED RETENTION $
<br />PER OTH-WORKERS COMPENSATION STATUTE ERAND EMPLOYERS' LIABILITY Y / N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $N / AOFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)E.L. DISEASE - EA EMPLOYEE $
<br />If yes, describe under
<br />E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / 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 />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />© 1988-2014 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORDACORD 25 (2014/01)
<br />CLEAHAR-01 SHELTONJE
<br />3/24/2016
<br />Willis Towers Watson Certificate Center
<br />Willis of Massachusetts, Inc.
<br />c/o 26 Century Blvd
<br />P.O. Box 305191
<br />Nashville, TN 37230-5191
<br />(877) 945-7378 (888) 467-2378
<br />Certificates@willis.com
<br />ACE American Insurance Company 22667
<br />Thermo Fluids Inc.
<br />14624 N. Scottsdale Rd., Suite 300
<br />Scottsdale, AZ 85254
<br />American Guarantee and Liability Insurance Company 26247
<br />Indemnity Insurance Company of North America 43575
<br />A X 2,000,000
<br />X X X HDOG2740067A 11/01/2015 11/01/2016 500,000
<br />X XCU 5,000
<br />X Contractual 2,000,000
<br />4,000,000
<br />X X 4,000,000
<br />5,000,000
<br />A X X X ISAH08860889 11/01/2015 11/01/2016
<br />X
<br />X
<br />X MCS-90
<br />XX 10,000,000
<br />B AUC 4275262-11 11/01/2015 11/01/2016 10,000,000
<br />0X
<br />X
<br />C X WLRC48592739 (AOS)11/01/2015 11/01/2016 2,000,000N
<br />2,000,000
<br />2,000,000
<br />A Workers Compensation WLRC48592715 (AZ, CA, MA)11/01/2015 11/01/2016 See Attached
<br />Kittitas County is named as an Additional Insured for General Liability and Auto Liability as their interests may appear if required by written contract but only
<br />with respect to liability arising out of operations of the Named Insured.
<br />It is understood and agreed that the company waives its right of subrogation which may arise by reason of a payment of claim under the General Liability,
<br />Auto Liability, Worker's Compensation policy(ies) as required by written contract where allowed by state law.
<br />Kittitas County
<br />925 S. Industrial Way
<br />Ellensburg, WA 98926
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