HomeMy WebLinkAboutBrookside Morgue Service AgreementPROFESSIONAL SERVICES AGREEMENT
This Agreement dated as of c� I iZeQ is made by and between Kittitas
County Coroner's Office/Coroner Nick Henderson (hereinafter "the Coroner") and
Brookside Funeral Home and Crematory and Jamin Mohler (hereinafter "Contractor"). The
Coroner and Contractor agree as follows:
General Conditions; Exhibit A (Scope of Work); Exhibit B (Compensation);
Exhibit C (Proof of Insurance).
copies of which are attached hereto and incorporated herein by this reference as fully as if
set forth herein.
The term of this Agreement shall commence on the September 1st, 2020 and
continue until December 31, 2025. Any party may terminate this Agreement by giving thirty
(30) days' notice in writing either personally delivered or mailed postage -prepaid by
certified mail, return receipt requested, to the party's last known address for the purposes
of giving notice under this paragraph.
Contractor acknowledges and by signing this Agreement agrees that the
Indemnification provisions set forth in Paragraphs 7 (Independent Contractor), 9 (Taxes),
15 (Defense and Indemnity Agreement), and 23 (Confidentiality), are totally and fully part
of this Agreement and have been mutually negotiated by the parties.
Professional Services Agreement
Page 1
IN WITNESS WHEREOF, the parties have executed this Agreement this __j__ day
of �' 2, 20 ) .
Jamin Mohler
Print Name of Signatory
APPROVED:
CORONER
KITTITAS CO NTY, WASHINGTON
Nick Hend rson
Approved:
BOARD OF COUNTY COMMISSIONERS
KITTITAS COUNTY, WASHINGTON
Brett Wachsmith, Chair
Laura Osiadacz, Vice -Chair
Cory Wright, Commissioner
Attest:
Clerk of the Board
Contractor Address: County's Address:
Brookside Funeral Home & Crematory Kittitas County
500 East Mountain View Avenue 205 West 5th Avenue, Suite 108
Professional Services Agreement
Page 2
Ellensburg, WA 98926 Ellensburg, WA 98926
GENERAL CONDITIONS
1. Scope of Contractor's Services:
Contractor agrees to provide to the Coroner services and any materials set forth in the
project narrative identified in Exhibit "A" during the Agreement period. No material or labor
will be furnished by the Coroner, unless otherwise provided for in the Agreement.
2. Performance of Work:
Contractor shall perform work in accordance with, and shall comply with, all the provisions
of this Agreement. All work shall comply with applicable codes and ordinances.
3. Schedule of Performance:
Unless directed otherwise by the Coroner, Contractor shall perform the work in
accordance with any schedules made a part of this Agreement.
4. Definitions:
4.1 "Additional Insured's" means the Coroner, its successors, and assigns, and
the respective directors, officers, employees, agents and representatives of
the Coroner and its successors and assigns.
4.2 "Support" means the following: Contractor's directors, officers, employees,
agents and representatives; and sub -Contractors of any tier; the respective
directors, officers, employees, agents and representatives of these sub -
Contractors of any tier; and any other person or entity acting under the
direction or control of, or on behalf of, Contractor or any Contractor's sub -
Contractors of any tier in connection with or incident to the performance of
the Work or this Agreement.
4.3 The "Work" means all the duties listed in Exhibit A and the performance of all
other obligations, under this Agreement by Contractor or its Support.
5. Accounting and Payment for Contractor Services:
Payment to the Contractor for services rendered under this Agreement shall be as set
forth in Exhibit "B". Where Exhibit "B" requires payments by the Coroner, payment shall be
based upon billings, supported unless otherwise provided in Exhibit "B", by documentation
of units of work actually performed and amounts earned, including where appropriate, the
actual number of days worked each month, total number of hours for the month, and the
total dollar payment requested. Unless specifically stated in Exhibit "B" or approved in
writing in advance by the Kittitas County Coroner's Office, the Coroner will not reimburse
Professional Services Agreement
Page 3
the Contractor for any costs or expenses incurred by the Contractor in performance of this
Agreement.
Where required, the Coroner shall, upon receipt of appropriate documentation,
compensate the Contractor, no more often than monthly, through the Coroner voucher
system, for the Contractor's service pursuant to the fee schedule set forth in Exhibit "B".
6. Assignment and Subcontracting:
No portion of this Agreement may be assigned or subcontracted to any other individual,
firm or entity without the express and prior written approval of the Coroner.
7. Independent Contractor:
The Contractor's services shall be furnished by the Contractor as an independent
Contractor and nothing herein contained shall be construed to create a relationship of
employer-employee or master -servant, but all payments made hereunder and all services
performed shall be made and performed pursuant to this Agreement by the Contractor as
an independent Contractor.
The Contractor acknowledges that the entire compensation for this Agreement is specified
in Exhibit "B" and the Contractor is not entitled to any Coroner benefits including, but not
limited to: vacation pay, holiday pay, sick leave pay, medical, dental, or other insurance
benefits, or any other rights or privileges afforded to Kittitas County employees.
Contractor will defend, indemnify and hold harmless the Coroner, its Additional Insured's,
officers, agents or employees from any loss or expense, including but not limited to
settlements, judgments, setoffs, attorneys' fees or costs incurred by reason of claims or
demands because of breach of the provisions of this paragraph.
8. No Guarantee of Employment:
The performance of all or part of this Agreement by the Contractor shall not operate to vest
any employment rights whatsoever and shall not be deemed to guarantee any
employment of the Contractor or any employee of the Contractor or any sub -Contractor or
any employee of any sub -Contractor by the Coroner at the present time or in the future.
9. Taxes:
The Contractor understands and acknowledges that the Coroner will not withhold Federal
or State income taxes. Where required by State or Federal law, the Contractor authorizes
the Coroner to make withholding for any taxes other than income taxes (i.e. Medicare). All
compensation received by the Contractor will be reported to the Internal Revenue Service
at the end of the calendar year in accordance with the applicable IRS regulations. It is the
responsibility of the Contractor to make the necessary estimated tax payments throughout
the year, if any, and the Contractor is solely liable for any tax obligation arising from the
Contractor's performance of this Agreement. The Contractor hereby agrees to indemnify
Professional Services Agreement
Page 4
the Coroner against any demand to pay taxes arising from the Contractor's failure to pay
taxes on compensation earned pursuant to this Agreement.
The Coroner will pay sales and use taxes imposed on goods or services acquired
hereunder as required by law. The Contractor must pay all other taxes including, but not
limited to: Business and Occupation Tax, taxes based on the Contractor's gross or net
income, or personal property to which the Coroner does not hold title. The Coroner is
exempt from Federal Excise Tax.
10. Regulations and Requirement:
This Agreement shall be subject to all laws, rules and regulations of the United States of
America, and State of Washington, and political subdivisions of the State of Washington,
and to any other provisions set forth herein or in the attached exhibits.
11. Right to Review:
This contract is subject to review by any Federal or State auditor. The Coroner or its
designee shall have the right to review and monitor the financial and service components
of this program by whatever means are deemed expedient by the Coroner. Such review
may occur with or without notice, and may include, but is not limited to, on-site inspection
by Coroner agents or employees, inspection of all records or other materials which the
Coroner deems pertinent to the Agreement and its performance, and any and all
communications with or evaluation by service recipients under this Agreement. The
Contractor shall preserve and maintain all financial records and records relating to the
performance of work under this Agreement for 3 years after contract termination, and shall
make them available for such review, within Kittitas County, State of Washington, upon
request.
12. Modifications:
12.1 Either party may request changes in the Agreement. All agreed
modifications shall be in writing, signed by each of the parties.
12.2 The Coroner may, at any time, by written notice thereof to Contractor
("Change Notice") makes changes in the Work within the general scope of
this Agreement, including, but not limited to: (a) changes in, revisions to,
substitutions for, additions to or deletions of any Work; (b) changes in
schedule; and (c) acceleration, deceleration or suspension of performance
of any Work.
12.3 If any change in the Work causes an increase or decrease on Contractor's
cost of, or the time required for, performance of the Work, an equitable
adjustment in the compensation to Contractor and in the schedule for the
performance of the Work shall be made to reflect such an increase or
decrease.
Professional Services Agreement
Page 5
12.4 Notwithstanding any dispute or delay in arriving at a mutually acceptable
equitable adjustment, Contractor shall proceed in accordance with all
Change Notices. Contractor must, within thirty (30) days after receipt of any
Change Notice that does not set forth any acceptable adjustment, submit to
the Coroner a written statement setting forth any adjustment claimed.
12.5 If any change results in a decrease in the Work performed, Contractor shall
be entitled to compensation associated with changing the Work, such as
revising design already completed, revising calculations already performed,
and revising documents.
13. Termination for Default:
If the Contractor defaults by failing to perform any of the obligations of the Agreement or
becomes insolvent or is declared bankrupt or commits any act of bankruptcy or insolvency
or makes an assignment for the benefit of creditors, the Coroner may, by depositing
written notice to the Contractor in the U.S. mail, postage prepaid, terminate the
Agreement, and at the Coroner's option, obtain performance of the work elsewhere. If the
Agreement is terminated for default, the Contractor shall not be entitled to receive any
further payments under the Agreement until all work called for has been fully performed.
Any extra cost or damage to the Coroner resulting from such default(s) shall be deducted
from any money due or coming due to the Contractor. The Contractor shall bear any extra
expenses incurred by the Coroner in completing the work, and all damage sustained, or
which may be sustained by the Coroner by reason of such default.
If a notice of termination for default has been issued and it is later determined for any
reason that the Contractor was not in default, the rights and obligations of the parties shall
be the same as if the notice of termination had been issued pursuant to the Termination for
Public Convenience paragraph hereof.
14. Termination for Public Convenience:
The Coroner may terminate the Agreement in whole or in part whenever the Coroner
determines, in its sole discretion that such termination is in the best interests of the
Coroner. Whenever the Agreement is terminated in accordance with this paragraph, the
Contractor shall be entitled to payment for actual work performed at unit contract prices for
completed items of work. In the event of such termination, an equitable adjustment shall
be made in the compensation payable to Contractor.
An equitable adjustment in the contract price for partially completed items of work will be
made, but such adjustment shall not include provision for loss of anticipated profit on
deleted or uncompleted work. Termination of this Agreement by the Coroner at any time
during the term, whether for default or convenience, shall not constitute a breach of
contract by the Coroner.
Professional Services Agreement
Page 6
The Kittitas County Board of County Commissioners may terminate this contract for public
convenience, to wit: if the county's budget circumstances are such that the count is unable
to meet its financial obligation.
15. Defense & Indemnity Agreement:
The Contractor agrees to and shall defend, indemnify and hold harmless the Coroner, its
Additional Insured's, appointed and elective officers, agents and employees, from and
against all loss or expense, including but not limited to judgments, settlements, attorney's
fees and costs by reason of any and all claims and demands upon the Coroner, its
Additional Insured's, its elected or appointed officials, agents, or employees for damages
because of personal or bodily injury, including death at any time resulting therefrom,
sustained by any person or persons and on account of damage to property including loss
of use thereof, whether such injury to persons or damage to property is due to the
negligence of the Contractor, its sub -Contractors, its elected officers, employees or their
agents, except only such injury or damage as shall have been occasioned by the sole
negligence of the Coroner, its Additional Insured's, appointed or elected officials, agents,
or employees. It is further provided that no liability shall attach to the Coroner by reason of
entering this contract, except as expressly provided herein.
16. Industrial Insurance Waiver:
With respect to the performance of this Agreement and as to claims against the Coroner,
its Additional Insured's, officers, agents and employees, the Contractor expressly waives
its immunity under Title 51 of the Revised Code of Washington, the Industrial Insurance
Act, for injuries to its employees and agrees that the obligations to indemnify, defend and
hold harmless provided in this agreement extend to any claim brought by or on behalf of
any employee of the Contractor. This waiver is mutually negotiated by the parties to
this Agreement.
17. Venue and Choice of Law:
In the event that any litigation should arise concerning the construction or interpretation of
any of the terms of this Agreement, the venue of such action of litigation shall be in the
Superior Court of the State of Washington in and for the County of Kittitas. This Agreement
shall be governed by the law of the State of Washington.
18. Withholding Payment:
In the event the Contractor has failed to perform any obligation to be performed by the
Contractor under this Agreement within the time set forth in this Agreement, then the
Coroner may, upon written notice, withhold all monies due and payable to Contractor,
without penalty, until such failure to perform is cured or otherwise adjudicated.
19. Future Non -Allocation of Funds:
If sufficient funds are not appropriated or allocated for payment under this Agreement for
any future fiscal period, the Coroner will not be obligated to make payments for services or
Professional Services Agreement
Page 7
amounts incurred after the end of the current fiscal period. No penalty or expense shall
accrue to the Coroner in the event this provision applies.
20. Contractor Commitments. Warranties and Representations:
Any written commitment received from the Contractor concerning this Agreement shall be
binding upon the Contractor, unless otherwise specifically provided herein with reference
to this paragraph. Failure of the Contractor to fulfill such a commitment shall render the
Contractor liable for damages to the Coroner. A commitment includes, but is not limited to
any representation made prior to execution of this Agreement, whether or not incorporated
elsewhere herein by reference, as to performance of services or equipment, prices or
options for future acquisition to remain in effect for a fixed period, or warranties.
21. Disputes:
21.1 General
Differences between the Contractor and the Coroner, arising under and by
virtue of the Agreement Documents shall be brought to the attention of the
Coroner at the earliest possible time in order that such matters may be
settled or other appropriate action promptly taken. Except for such
objections as are made of record in the manner hereinafter specified and
within the time limits stated, the records, orders, instructions, and decisions
of the Kittitas County Prosecuting Attorney/Coroner shall be final and
conclusive.
21.2 Notice of Potential Claims
The Contractor shall not be entitled to additional compensation which
otherwise may be payable, or to extension of time for (1) any act or failure to
act by the Coroner, or (2) the happening of any event or occurrence, unless
the Contractor has given the Coroner a written Notice of Potential Claim
within ten (10) days of the commencement of the act, failure, or event giving
rise to the claim, and before final payment by the Coroner. The written
Notice of Potential Claim shall set forth the reasons for which the Contractor
believes additional compensation or extension of time is due, the nature of
the cost involved, and insofar as possible, the amount of the potential claim.
Contractor shall keep full and complete daily records of the work performed,
labor and material used, and all costs and additional time claimed to be
additional.
21.3. Detailed Claim
The Contractor shall not be entitled to claim any such additional
compensation, or extension of time, unless within thirty (30) days of the
completion of the portion of the work from which the claim arose, and before
final payment by the Coroner, the Contractor has given the Coroner a
Professional Services Agreement
Page 8
detailed written statement of each element of cost or other compensation
requested and of all elements of additional time required, and copies of any
supporting documents evidencing the amount or extension of time claimed
to be due.
22. Ownership of Items Produced:
All writings, programs, data, public records, or other materials prepared by the Contractor
and/or its consultants or sub -Contractors, in connection with performance of this
Agreement shall be the sole and absolute property of the Coroner.
23. Confidentiality:
The Contractor, its employees, sub -Contractors, and their employees shall maintain the
confidentiality of all information provided by the Coroner or acquired by the Contractor in
performance of this Agreement, except upon the prior written consent of the Kittitas
County Prosecuting Attorney or an order entered by a court after having acquired
jurisdiction over the Coroner. Contractor shall immediately give to the Coroner notice of
any judicial proceedings seeking disclosure of such information. Contractor shall indemnify
and hold harmless the Coroner, its Additional Insured's, officials, agents or employees
from all loss or expense, including, but not limited to settlements, judgments, setoffs,
attorneys' fees and costs resulting from Contractor's breach of this provision.
24. Notice:
Except as set forth elsewhere in the Agreement, for all purposes under this Agreement,
except service of process, notice shall be given by the Contractor to the Kittitas County
Coroner, 507 N Nanum St, Suite 113A, Ellensburg, WA 98926. Notice to the Contractor for
all purposes under this Agreement shall be given to the address reflected on the signature
page. Notice may be given by delivery or by depositing in the U.S. Mail, first class, postage
prepaid.
25. Severabilitv:
If any term or condition of this Agreement or the application thereof to any person(s) or
circumstances is held invalid, such invalidity shall not affect other terms, conditions or
applications which can be given effect without the invalid term, condition or application. To
this end, the terms and conditions of this Agreement are declared severable.
26. Miscellaneous:
26.1 The Coroner's failure or delay to insist upon strict performance of any of the
provisions of this Agreement or to exercise any rights or remedies under this
Agreement shall not be construed as a waiver or relinquishment to any
extent of its right to assert or rely upon any such provisions, rights or
remedies in that or any other instance; rather the same shall be and remain
in full force and effect.
26.2 This Agreement embodies the entire Agreement between the Coroner and
Contractor, and supersedes all prior agreements, regarding the Work. No
Professional Services Agreement
Page 9
change, amendment, or modification of any provisions of this Agreement
shall be valid unless set forth in a written instrument signed by the party to
be bound thereby.
26.3 The rights and remedies of the Coroner set forth in any provision of this
Agreement are in addition to and do not in any way limit any other rights of
remedies afforded to the Coroner by any other provisions of this Agreement,
by any of Contractor's Support or by law.
26.4 The headings of sections and paragraphs of this Agreement are for
convenience of reference only and are not intended to restrict, affect or be
of any weight in the interpretation or construction of the provisions of such
sections or paragraphs.
27. Waiver:
Waiver of any breach or condition of this Agreement shall not be deemed a waiver of any
prior or subsequent breach. No terms or conditions of this Agreement shall be held to be
waived, modified, or deleted except by an instrument, in writing, signed by the parties
hereto.
28. Survival:
The provisions of paragraphs 7, 9, 11, 13, 14, 15, 16, 17, 18, 19, 20, 21, 25, 27, and 29,
shall survive, notwithstanding the termination or invalidity of this Agreement for any
reason.
29. Nondiscrimination:
29.1 The Coroner is an equal opportunity employer.
29.2 Nondiscrimination in Employment
In the performance of this Agreement, the Contractor will not discriminate
against any employee or applicant for employment on the grounds of race,
creed, color, national origin, sex, marital status, age or the presence of
any sensory, mental or physical handicap; provided that the prohibition
against discrimination in employment because of handicap shall not apply
if the particular disability prevents the proper performance of the particular
worker involved. The Contractor shall ensure that applicants are
employed, and that employees are treated during employment without
discrimination because of their race, creed, color, national origin, sex,
marital status, age or the presence of any sensory, mental or physical
handicap. Such action shall include, but not be limited to: employment,
upgrading, demotion or transfers, recruitment or recruitment advertising,
layoff or
termination, rates of pay or other forms of compensation, and programs
for training including apprenticeships. The Contractor shall take such
action with respect to this Agreement as may be required to ensure full
Professional Services Agreement
Page 10
EXHIBIT "A"
SCOPE OF WORK
Upon request of the County Coroner, the Contractor shall provide the following services
as directed by the Coroner:
The Contractor shall provide reverent, timely, and professional body processing, organ
procurement support services, and autopsy support services 24 hours a day, seven
days a week.
The Contractor shall respond at request of the Coroner to the scene, from Ellensburg,
within a reasonable drive time (weather and traffic conditions considered).
The Contractor shall perform removal and transport of bodies from the scene to the
morgue. The Contractor shall provide no less than two employees to the scene for
removal and transport of bodies.
The Contractor shall perform all lifting and transferring of the body to the autopsy table
and from the autopsy table back to storage when necessary.
The Contractor shall work with with Organ Procurement Organizations (OPO) to ensure
timely organ donation occurs when organ procurement is approved by the Coroner.
The Contractor shall store the body until it is released by the Coroner.
The Contractor shall provide indigent cremation when requested to do so by the
Coroner.
The Contractor, when they are chosen to provide funeral services for the deceased,
shall start Electronic Death Registration System (EDRS) reports for all cases in which
the Kittitas County Coroner's Office has jurisdiction over the remains.
The County Coroner may on occasion call upon more than one contractor at a time to
provide any of the services listed above.
The County Coroner may on occasion store operating supplies for autopsies at the
Contractor's facility. These supplies shall only be used for Coroner business.
Professional Services Agreement
Page 12
compliance with local, state and federal laws prohibiting discrimination in
employment.
29.3 Nondiscrimination in Services
The Contractor will not discriminate against any recipient of any services
or benefits provided for in this Agreement on the grounds of race, creed,
color, national origin, sex, marital status, age or the presence of any
sensory, mental or physical handicap.
29.4 If any assignment and/or subcontracting has been authorized by the
Coroner, said assignment or subcontract shall include appropriate
safeguards against discrimination. The Contractor shall take such action
as may be required to ensure full compliance with the provisions in the
immediately preceding paragraphs herein.
30. Criminal conduct:
Contractor agrees that they will immediately notify the Coroner if contractor is convicted of
a crime.
Professional Services Agreement
Page 11
EXHIBIT "B"
COMPENSATION
The Coroner will pay the Contractor on a case by case basis determined by use for the
duration of this contract September 1St, 2020 to December 31St, 2025, for the performance
of morgue services in Kittitas County. Payments to Contractor will be made in monthly
according to invoices in the following manner:
• Payment for Facilities $300.00
• Payment for Transfer $499.00
• Indigent Cremation $863.00
EXHIBIT "C"
PROOF OF INSURANCE
The Contractor shall secure and maintain in effect at all times during performance of the
Work such insurance as will protect Contractor, its Support and the Additional Insured's
from all claims, losses, harm, costs, liabilities, damages and expenses arising out of
personal injury (including death) or property damage that may result from performance
of the work or this Agreement, whether such performance is by Contractor or any of its
Support.
All insurance shall be issued by companies admitted doing business in the State of
Washington and have a rating of A-, Class VII or better in the most recently published
edition of Best's Reports unless otherwise approved by the Coroner. If an insurer is not
admitted, all insurance policies and procedures for issuing the insurance policies must
comply with Chapter 48.15 RCW and 284-15 WAC.
All coverage provided by the Contractor shall be primary and non-contributory. The
Contractor shall provide proof of insurance for Commercial (comprehensive) General
Liability insurance with coverage limits not less than $1,000,000 combined single limit
per occurrence. Proof of a policy of Automobile Liability Insurance, including coverage
for owned, non -owned, leased, or hired vehicles written on an insurance industry
standard form or equivalent. Worker's Compensation shall be in the amount required by
law. The Contractor shall furnish the Coroner a certificate of insurance (with
Endorsement as evidence that policies providing insurance required by this Agreement
are in full force and effect. The type of insurance required by this Agreement is marked
below.
/1)Commercial General Liability Insurance
Thirty (30) days written notice to the Coroner of cancellation
Professional Services Agreement
Page 13
the insurance policy.
2) Workers' Compensation.
rkers' Compensation in amounts required by law.
L9'3) Automobile Liability Insurance.
Thirty (30) days written notice to the Coroner of cancellation
of the insurance policy.
NOTE: No contract shall form until and unless a copy of the Certificate of Insurance,
properly completed and in the amount required, is attached hereto.
Professional Services Agreement
Page 14
COVERAGES CERTIFICATE NUMBER: 11 REVISION NUMBER:O
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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS
AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
WMO9
A� CERTIFICATE OF LIABILITY INSURANCE
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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(ies) must have ADDITIONAL INSURED provisions or 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 rl ms to the Certificate holder In )leu of such endorsement B .
PRODUCER
FEDERATED MUTUAL INSURANCE COMPANY
HOME OFFICE: P.O. BOX 328
CONTACT
NAME: CLIENT CONTACT CENTER
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ADDRRESS, CUENTCONTACTCENTER FEDINS. OM
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INSURER A: FEDERATED MUTUAL INSURANCE COMPANY 13935
DAMAGE TO RENTED $1OD,000
INSURED 773-992_9
INSURER B:
BROOKSIDE FUNERAL HOME & CREMATORY, INC.
PO BOX 1267
INSURER C:
INSURER D:
MOXEE, WA 98936-1267
INSURER E:
PRODUCTS - COMPIOP AGO $2,000,000
UIURER F:
A
COVERAGES CERTIFICATE NUMBER: 11 REVISION NUMBER:O
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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS
AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
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E.L. DISEASE EA EMPLOYEE $1,OD%oOD
L DISEASE POLICY OMIT E. $1,000ADO
DESCRIPTION OF OPERATIONS I LOCATIONS, VEHICLES (MORD 101. M&IN.1 Rem.Wa Si ule. mey M eNNeE it DI.. fpex is rMuired)
STOP -GAP (EMPLOYER'S LIABILITY) COVERED STATE(S) WA
500 E MOUNTAIN VIEW, ELLENSBURG, WA
CERTIFICATE HOLDER CANCELLATION
173-9925
110
KITTATAS COUNTY CORONER'S OFFICE
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
507 N NANUM ST STE 113
THE EXPIRATION DATE THEREOF, NOTICE
WILL BE DELIVERED IN
ELLENSBURG, WA 98928.2886
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATTII/VEE
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(D IM -2015 ACORD CORPORATION. MI rights reserved.
ADDING 25 (2011003) The ACORD name and logo are registered (narks of ACORD