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FOFM �� STATE OF WASHINGTON THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY. THIS <br />SF 500A CERTIFICATEpOES NOT AMEND, EXTEND OR ALTER THE COVEFJ.GE AFFORDED BY <br />(7/2/92) Q' CERTIFICATE OF INSURANCE THE POLICIES SOW <br />INSURED (Legal name and busmen address( CERTIFICATE HOLDER: CONTRACT <br />STATE OF WASHINGTON <br />DEPT OF GENERAL ADMINISTRATION <br />DA7 t¢.o I F Milli <br />R )MINISTRATION I 1 <br />OLYMPIA, WA 98504 <br />PRQIECT DESCRIPTION / LOCATIONS / VEHICLES / RESTRICTIONS / SPECIAL ITEMS <br />This is <br />TYPE OF INSURANCE <br />:NERAL LIABILITY <br />Commercial General Liability <br />Claims Made ^) Occurrence <br />Dwner's 6 Contractors Protective <br />AUTOMOBILE LIABILITY <br />Any Auto <br />i All Owned Aulos <br />li Scheduled Aulos <br />Hirea Autos <br />NcTOWned Au!os <br />1 Garage Liability <br />Deduclible <br />EXCESS LIABILITY <br />WORKER'S COMPENSATION <br />AND <br />EMPLOYER'S LIABILITY <br />arHER <br />to <br />Effective <br />Policy j ALL LIMITS IN THOUSANDS <br />Bodily <br />Injury <br />er erson) <br />Bodily <br />Injury <br />(per accident) <br />Property <br />Damage IS <br />Octurarence <br />ch <br />f <br />The State of Washington is included as additional insured as related to the above mentioned project. <br />Should any of the above described policies be cancelled before the expiration data thereof, the Issuing Company must deliver or mall not less [hall a 45 <br />days written notice to the above Certificate Holder, per RCW 48.18.290. <br />COMPANIES AFFORDING COVERAGES ISSUING COMPANY, AGENT OR REPRESENTATIVE <br />NOTE: Attach a separate shoal to this certificate giving <br />all the company names and their percentage of NAAIE: - <br />coverage, it clarification is needed. - <br />ADDRESS: <br />ized Signature <br />Title <br />Signature Date <br />Signee Name <br />Telephone No <br />