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Image (41)o Ali n CERTIFICATE OF LIABILITY INSURANCE DATE (MWDDJYYYY) 5/1/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIONONLY 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'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 lieu of such endorsement(s). PRODUCER Acrisure, LLC dba Britton Gallagher & Associates 3737 Park East Dr. STE 204 Beachwood OH 44122 CONTACT NAME: PHONE 216-658-7100 FAAic No): 216-658-7101 -MAIL ADDRESS: INSURER(SLFFORDINl3,cOVERAGE _..__......_....___........... � _..__....... _.._.........._....._.__. __._.__._._...._...._ INSURER A: Arch Speciality Ins CO 21199 INSURED 2567 INSURER B . LeXintjtOn InS Co ,_19437 Jake's Fireworks Inc. 1500 E 27th Terr. INSURER C : Pittsburg KS 66762 INSURER D : INSURER E , INSURER F: COVERAGES CERTIFICATE NUMBER:1025929097 REVISION NUMBER: 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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I LTR OF INSURANCE SUBR ADDLTYPE POLICY NUMBER MMNCDIYYFF MMOIDICY (YM EXP LIMITS B GENERAL LIABILITY 052115105 2/1512024 2/1512025 EACH OCCURRENCE $1,000,000-DAMAGE TO RENTED PREMISES Es occurrence $ 5K000_ COMMERCIAL GENERAL LIABILITY MED_EXP (Any one person) $ CLAIMS -MADE % OCCUR PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 ; $ POLICY PRO- X JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ AALL UTOS OWNED SCHEDULED AUTOS NON -OWNED HIRED AUTOS AUTOS ; ! ': PROPERTY DAMAGE Per accident $ $ A UMBRELLA LIAB 1 X OCCUR UXP1037038-04 2/1512024 2115/2025 EACH OCCURRENCE ......._........._....._......_._..._.._..._._.__..........._ $1,000,000 ....._........ . ............ X EXCESS LIAB CLAIMS -MADE j AGGREGATE $1,000,000 DED RETENTION S WORKERS COMPENSATION TH- WOR C STATULIMIS OPR $ E.L. EACH ACCIDENT $ AND EMPLOYERS' LIABILITY Y t N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. DISEASE - EA EMPLOYEE $ �^ OFFICERIMEMBER EXCLUDED? ❑ (Mandatory In NH) N 1 A j if yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ i DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, N more apace Is required) Additional insured extension of coverage is provided by above referenced General Liability policy where required by written agreement. Sales Location: 16628 State Route 507 SE, Yelm, WA 98597; Land Owner: Tim Baublits; Ken Kersey, P.0 Box 1106, McKenna, WA 98558; City of Yelm and all its employees, 105 W. Yelm Ave., Yelm, WA 98597; Christensen's Furniture and all it's employees Term: February 15, 2024 through February 14, 2025; The Certificate Holder and the above listed are Additional insureds with respects to General Liability policy as required by written contract. TE Ken Kersey PO Box 1106 McKenna WA 98558 ACORD 26 (2010105) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD