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