Laserfiche WebLink
RIVERSO-01 MGRIFFANTI <br />ACORD" CERTIFICATE OF LIABILITY INSURANCE I <br />DATE (MMIDDIYYYY) <br />~ 1116/2015 <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 />PRODUCER License # CA#0658748 CONTACT <br />NAME: <br />AHT Insurance r1l8 N"jo Extd703) 777-2341 I r"e~ No): (703) 771-1852 20 S. King Street E·MAIL Leesburg, VA 20175 ADDRESS: <br />INSURER(S) AFFORDING COVERAGE NAIC # <br />INSURER A: Hartford Accident and Indemnity Company 22357 <br />INSURED INSURER B : Sentinel Insurance Company Ltd 11000 <br />American Rivers, Inc. INSURER c: Hartford Casualty Insurance Company 29424 <br />110114th Street, NW, Suite 1400 INSURER 0 : Hartford Underwriters Insurance Company 30104 <br />Washington, DC 20005 INSURER E: <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER' REVISION NUMBER' ._. <br />TH)S IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR I HE 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 ADD :suBR I I~~~J%M~) l~g~J%~) LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER LIMITS <br />A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 r--~ CLAIMS-MADE 0 OCCUR 42UUNZI6055 11/08/2015 11/08/2016 ~~~~~~~ (E~~~~';;~nce) 300,000 X X $ r-- <br />10,000 MED EXP (Anyone person) $ r-- <br />1,000,000 <br />I------PERSONAL & ADV INJURY $ <br />R'L AGG REGATE LIMIT APPLIES PER : GENERA L AGG REGATE $ 2,000,000 <br />D PRO-D PRODUCTS -COMP/OP AGG $ 2,000,000 POLICY JECT LOC <br />OTHER: EBL AGGREGATE $ 2,000,000 <br />AUTOMOBILE LIABILITY PE~~~~~~~t~'NGLE LIMIT $ 1,000,000 <br />B I------42UUNZI6055 11/08/2015 11/08/2016 ANY AUTO X X BODILY INJURY (Per person ) $ <br />r-~ ALL OWNED ,-SCHEDULED <br />AUTOS AUTOS BODILY INJ URY (Per accident) $ <br />7 7 NON-OWNED rp~?~~C~d~~t?AMAGE $ HIRED AU TOS AUTOS ~ I------ <br />$ <br />~ UMBRELLA L1AB M OCCUR EACH OCCURRENCE $ 3,000,000 <br />C EXCESS L1AB CLAIMS-MADE 42RHUZI6471 11/08/2015 11/08/2016 AGGREGATE $ 3,000,000 <br />OED I X I RETENTION $ 10,000 $ <br />WORKERS COMPENSATION XJ ~ffTUTE I j OTH- <br />AND EMPLOYERS' LIABILITY ER <br />0 YIN X 42WECK7493 11/08/2015 11/08/2016 1,000,000 ANY PROPRIETOR /PARTNER /EXECUTIVE <br />D <br />E.L. EACH ACCIDENT $ <br />OFF ICER/MEMBER EXCLUDED? N/A <br />(Mandatory In NH) E.L. DISEASE -EA EMPLOYEE $ 1,000,000 <br />:f ,e~, de3crit;e unde:- <br />DESCRIPTION OF OPERATIONS below E.L. DISEASE -FOLiCY L:M1T $ 1,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD tOl, Additional Remarks Schedule, may be attached if more space is required) <br />Certificate Holder, the County, its successors, and assigns, and the respective directors, officers, employees of the County and its successors and assigns <br />are Additional Insureds on a primary and non-contributory basis under General Liability and Automobile Liability as required by written contract. A Waiver of <br />Subrogation applies in favor of Certifcate Holder under General Liability, Automobile Liability and Workers Compensation as required by written contract. <br />CERTIFICATE HOLDER CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Kittitas County <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />205 West 5th Avenue, Suite 108 <br />Ellensburg, WA 98926 <br />AUTHORIZED REPRESENTATIVE <br />I <br />~4,:.-{[j <br />© 1988-2014 ACORD CORPORATION. All nghts reserved. <br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD