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DVAC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/29/2011 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 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). CONTACT Joel Mai PRODUCER NAME: FAX PHONE (800)563-1871 Sunflower Insurance Group, Inc. (785)825-5098 (A/C, No): (A/C, No, Ext): E-MAIL jmai@sunflowerinsurance.com 2090 S. Ohio ADDRESS: PRODUCER 00003022 P.O. Box 1213 CUSTOMER ID #: Salina KS 67402-1213 INSURER(S)AFFORDINGCOVERAGE NAIC# Oklahoma Surety INSURED INSURER A : Accident Fund Ins Co of Am 10166 INSURER B : Domestic Violence Association of Central The Hartford INSURER C : PO Box 1854 INSURER D : 201-203 S Santa Fe INSURER E : Salina KS 67402 INSURER F : 12/13 GL, 11/12 WC, D&O COVERAGES CERTIFICATENUMBER:REVISIONNUMBER: 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. ADDLSUBR INSR POLICY EFF POLICY EXP TYPE OF INSURANCE LIMITS POLICY NUMBER (MM/DD/YYYY)(MM/DD/YYYY) LTR INSRWVD 1,000,000 GENERAL LIABILITY EACHOCCURRENCE$ DAMAGE TO RENTED X 100,000 COMMERCIAL GENERAL LIABILITY$ PREMISES(Eaoccurrence) 2/1/2012 2/1/2013 A X EXCLUDED X 06GL000841160 CLAIMS-MADE OCCUR MEDEXP(Anyoneperson)$ EXCLUDED PERSONAL&ADVINJURY$ 1,000,000 GENERAL AGGREGATE$ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:PRODUCTS - COMP/OP AGG$ PRO- X $ POLICY LOC JECT COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY 1,000,000 $ (Eaaccident) ANY AUTO BODILYINJURY(Perperson)$ 06GL000841160 2/1/2012 2/1/2013 A ALL OWNED AUTOS BODILYINJURY(Peraccident)$ SCHEDULEDAUTOS PROPERTY DAMAGE $ X (Peraccident) HIRED AUTOS X $ NON-OWNED AUTOS $ UMBRELLA LIAB EACHOCCURRENCE$ OCCUR EXCESS LIAB CLAIMS-MADE AGGREGATE$ $ DEDUCTIBLE $ RETENTION$ WC STATU-OTH- WORKERS COMPENSATION B X TORY LIMITS ER AND EMPLOYERS' LIABILITY Y / N 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACHACCIDENT$ N / A OFFICER/MEMBER EXCLUDED? 5/18/20115/18/2012 WCV6065796 500,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ Ifyes,describeunder 500,000 E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS below C Directors and Officers 11/1/201111/1/2012 1,000,000 NOA0004480 Limit 2,500 Deductible DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Salina is named as an additional insured with regard to general liability, but only with respect to work performed by Domestic Violence Association of Central Kansas. CERTIFICATE HOLDER CANCELLATION coi@salina.org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Salina 300 W Ash AUTHORIZED REPRESENTATIVE Salina, KS 67401 A Merrigan/AMERRI ACORD25(2009/09)©1988-2009ACORDCORPORATION.Allrightsreserved. TheACORDnameandlogoareregisteredmarksofACORD INS025 (200909)