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Salina/Saline County Health Department CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 6/28/2012 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 Alisa Jones PRODUCER NAME: FAX PHONE (800)563-1871 Assurance Partners (785)825-5098 (A/C, No): (A/C, No, Ext): E-MAIL ajones@yourassurance.com 2090 S Ohio ADDRESS: PRODUCER 00001417 PO Box 1213 CUSTOMER ID #: Salina KS 67402-1213 INSURER(S)AFFORDINGCOVERAGE NAIC# Travelers Indemnity Company 25658 INSURED INSURER A : Travelers Property Casualty Co 25674 INSURER B : Salina/Saline County Health Department INSURER C : 625 E North INSURER D : INSURER E : Salina KS 67401-2315 INSURER F : 12/13 Auto Rnwl 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 GENERAL LIABILITY EACHOCCURRENCE$ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY$ PREMISES(Eaoccurrence) CLAIMS-MADE OCCUR MEDEXP(Anyoneperson)$ PERSONAL&ADVINJURY$ GENERAL AGGREGATE$ GEN'L AGGREGATE LIMIT APPLIES PER:PRODUCTS - COMP/OP AGG$ PRO- $ POLICY LOC JECT COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY 1,000,000 $ (Eaaccident) X ANY AUTO BODILYINJURY(Perperson)$ BA6646R663 6/27/20126/27/2013 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 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACHACCIDENT$ N / A OFFICER/MEMBER EXCLUDED? 1/1/2012 1/1/2013 UB-2B954285 1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ Ifyes,describeunder 1,000,000 E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Employment Practices Liability Coverage - Limit $1,000,000 Deductible $15,000 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 St AUTHORIZED REPRESENTATIVE Salina, KS 67401 Leamon Bailey/LBAILE ACORD25(2009/09)©1988-2009ACORDCORPORATION.Allrightsreserved. TheACORDnameandlogoareregisteredmarksofACORD INS025 (200909) Additional Named Insureds Other Named Insureds City of Salina and Saline County-Joint Authority Salina/Saline County Health Board Saline County Animal Shelter OFAPPINF (02/2007)COPYRIGHT 2007, AMS SERVICES INC