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Insurance Certificate for BiCenter Cell Tower ACOR ® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDONYYY) ke.mr/ 12/5/2019 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). . PRODUCER - CONTACT Doris Pilatus .. NAME: Insurance Planning Inc. • PHONE ,0111 (785)625-5605141X.Not: ("Si szs-saes • 3006 Broadway•Avenue EMAIL pilado@insurance- lannin com ADDRESS: • P 9' • P. 0. Box 100 INSURER(S) AFFORDING COVERAGE NAIL a Hays KS 67601 wsuR6RA:COntinental'Western Insur Co. 10805 INSURED INSURER B: sex-Tech Wireless L.L.C. , INSURER C: 3001 New Way INSURER 0: INSURER E: Hays KS 67601 INSURER F: COVERAGES CERTIFICATE NUMBER:20/21 Certs 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. ILTR I TYPE OF INSURANCE I;.°°,WVD BR I POLICY NUMBER I IMIONJDDYEFF IYYYYI I(MM DDYEXP IYYYYI I LIMITS X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000 A I CLAIMS-MADE X OCCUR PRMISES Es RENTED 600,000 PREMISES ( Ea occurrence) 5 RUP272175133 1/1/2020 1/1/2021 MED EXP(Any one person) 5 10,000 PERSONAL S.ADV INJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: • . GENERAL AGGREGATE 5 2.000,000 X POLICY I •I ;PeiI I LOC PRODUCTS-COMP/OPAGG 5 2,000,000 OTHER' ' I Employee Benefits 5 1,000,000 •AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5 1,000,000 JEa amaentl A X' ANY AUTO BODILY INJURY(Per person) 5 ALL OKNEO SCHEDULED RUP272175133 1/1/2020 1/1/2021 BODILY INJURY"(Per accident) 5 X'1 AUTOS AUTOS • NON-0KNED . PROPERTYdnt)DAMAGE 5 HIREOAUTOS AUTO$ - Per accident) 5 X UMBRELLA LIAB X I OCCUR EACH OCCURRENCE 5 10,000,000 A EXCESS LIAB I CLAIMS-MADE AGGREGATE 5 10,000,000 IDED I X I RETENTION 5 0 RUP2T2175133 1/1/2020 1/1/2021 5 WORKERS COMPENSATION No coverage Afforded -`1 07H- AND EMPLOYERS'LIABILITY YIN I $TATDTE I IRR ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT S OFFICEPoMEMBER EXCLUDED? -- (Mandatory Ln.NH)—- . -- - __- _ - - -EL-DISEASE-.EAEMPLOYEE' .5--- IIyes.Cescnoe ander DESCRIPTION OF OPERATIONS below I EL.DISEASE-POLICY LIMIT 5 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,nay be attached It mon space Is required) RE: Bicentennial Tower Salina KS 30 day notice is no longer applicable in KS. Certificate holder is an additional insured in regards to the Gen Liab S Auto Liability if required by written contract or agreement. . Waiver of Subrogation applies to the General Liability, 6 Auto Coverage. Gen Liab is Primary S Non Contributory. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Salina THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 736 Salina, KS 67402-0736 AUTHORIZED REPRESENTATIVE Doris Pilatus/PILADO ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201e01) • ACO CERTIFICATE OF LIABILITY INSURANCE . - - DATE(MMJDD"•Y) � "----. - 12/20/2018- 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.holdei in lieu-of such endorsement(s). PRODUCER _ - -- CUN,AI.t Doris Pi latus _ _ - -• PHO Insurance,.Planning-Inca.,:; (ACNE (785)625-5605 . . .... - -IF^%-- ,Tem us-Oer- _ _ (AK No Ertl: _ (uC.No/: 3006 Broadway Avenue ' E-MAI c55: P- 9 piladoGinsurance- tannin cam-- -- - - -- 400R P. 0. Box 100- • INSUREWS)AFFORDING COVERAGE-. -_ ' I NAIL v ., Hays . KS 67601 INSURER a:Continental Western Insur Co. 110804 .. INSURED • INSURER B: • Nex-Tech Wireless L.L.C., • INSURER C: 3001 New Way INSURER O: - INSURER E: I • Hays KS 67601 INSURERF: I . COVERAGES CERTIFICATE NUMBER:19/20 Cert 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. LIPai TYPE OF INSURANCE IPSDI WVD POLICY NUMBER SR I(MMDDWVYYI I(MMEFF /DDNYY) LIMITS • X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE I $ 1,000,000 •A • CLAIMS-MADE n OCCUR DAMAGE TO &urr _. - 600,000 . PREMISES(Eas oda:me:VW S RDP212175134 _ 1/1/2019 . 1/1/2020-. MED EXP(My one Perion)- 5 ----57000 ... - PERSONAL a'AD`/'INJURY 5 ,.��-1;000;000- . GENL AGGREGATE LIMIT APPLIES PER _ GENERAL AGGRcG=iE 5 X I.POLICY ❑PO- 2 n LOC .D00;G00 -� . .. -I AUTOMOBRE DABNTY• '..' "... 'T- :':' - EOMBwEDSINGLE TIT A 1 „�aenu -- s oap,oxo 'A- 'X, ANY AUTO. :-- :: :--. ..-• '~' _- •" - BODILY INJURY(Per xenon) $ • - ALL OWNED" - SCHEDULED'_- "n272175134 ' 1/1/2019,' 1/1/2020 BODILY INJURY(Per accident S AUTOS NOTOS _ I NON-0WNED - - PROPERTY DAMAGE X HIRED AUTOS • %. AUTOS - • • • •.jPer awoentt S _ I X IUMBRELLALIAR X OCCUR -- - - EACH OCCURRENCE $ 10,000,000 .---.A -I IEXCESS UAB CLAIMS-MADE AGGREGATE I5 10,000,000_ DED 1'X RETENTION 5 0 801272175134 1/1/2019 1/1/2020 15 WORKERS COMPENSATION IPER STATUTE I 10TH AND EMPLOYERS'LIABILITY ANY PROPRIETORJPARTNERIEXECUTNE YINNo Coverage Afforded E.L.EACH ACCIDENT S OFFIOERIMEMBER EXCLUDED? n NIA • - - - - - IMandaloryinNH) - - _ -- - -- - - - -- E.L.DISEASE-EA EMPLOYEE I5 rn I:yes.desbe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT 5 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be aEached it more space is required) RE: Bicentennial Tower Salina AS 30 day notice is no longer applicable in %S. Certificate holder is an additional insured in regards to the Gen Liab & Auto Liability. Waiver of Subrogation applies to the General Liability, & Auto Coverage. Gen Liab is Primary & Non Contributory, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Sal THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 736 Salina, KS 67402-0736 AUTHORIZED REPRESENTATIVE , r% Doris Pilatus/PILADO /Y9UQ ,4l Qj I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) AC ®. . CERTIFICATE OF LIABILITY INSURANCE (MWDDIVYY YY) 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). - . , - PR000LER r ° CONTACT Doris Pilatus - - - NAME: - - - InsUrarice Planning IRC. PHONE Est), (785)625-5605. -- -: I(NAXC No): (785)625-8388. . ,- E-MAIL - - . . 3006-Broadway Avenue --- -- - . ADDREss:pilado@insurance:planning.coin, - .• , • P,: 0.. Box . 100 •• INSURER(S)AFFORDING COVERAGE ' ' NAIC a- Hays •KS 67601 . INSURER A:Continental Western Insur Co. 10804 INSURED • INSURER B:Riverport Insurance Company 36684. Hex-Tech Wireless LLC, INSURER C: 3001 New Way INSURER D: INSURER E: Hays RS 67601 INSURERF: COVERAGES CERTIFICATE NUMBER:18/19 Certs w/ WC 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. ILTR I TYPE OF INSURANCE NSR AN D�SWVD I POLICY NUMBER I(MM%ODTYYYY)I(MM ODWYYY)I LIMITS X I COMMERCIAL GENERAL LIABILITY - . . _ EACH OCCURRENCE Is 1,000,000 DAMAGE TO RENTED "A I '- CLAIMIS '"600,000 CLAMS-MADE X OCCUR •..• :'PREMISES(Ea occurrence) RUP272175131 i - -•.1/1/2018: 1/1/2019_MED EXP.(Any One person) -I5 • _, _ PERSONAL ADMINJURY:- I.S--. 1,'.000,000 GENL AGGREGATE LIMIT APPLIES PER' - - GENERAL AGGREGATE -I S '2,000,-000 XPOLICY. jE� (FLOC - - - �- - -- - - - PRODUCTS COMPK)PAGG I5 --- -2,000;000 ..I OTHER: • A IAUTOMOBILE UABIUTY "` •-.. .' - va-% - . COMBINED�ceISINGLE LIMIT 15 1,000,000 X I ANY AUTO ._ .... _ - ._.. BODILY INJURY(Per person) 15 ALL OWNED F�ISCHEDULED RUP272175131 . 1/1/2018 1/1/2019 'BODILY INJURY(Per accident4$ AUTOS �I II_,I AUTOS • NON-0 ' ' PROPERTY DAMAGE X HIRED AUTOS 12i I gUT05WNED - - - _(Per accident) 5 S . I X I UMBRELLA LIAR I IOCCUR •• "' EACH OCCURRENCE $ - 10,000,000 A I I EXCESS LIAB I I CLAIMS-MADE AGGREGATE 5 10,000,000 I I DED I X I RETENTIONS 0 RUP272175131 1/1/2018 1/1/2019 5 (WORKERS COMPENSATION I I [EL x I STATUTE I I EERH AND EMPLOYERS'LIABILITY y I N ANY PROPRIETORm4DTNEo xECUTIVE-r� .u.A^_CI^_=•:T-_ S 1.000.000. -- B OFFICERIMEMBER EXCLUDED? I i NIA - (MandatoryInNH) RSAAP308556 9/15/20189/15/2019 E.L.DISEASE-EA EMPLOYEES 1,000,000 It yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 15 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space Is required) RE: Bicentennial Tower Salina RS 30 day notice is no longer applicable in RS. Certificate holder is an additional insured in regards to the Gen Liab & Auto Liability. Waiver of Subrogation applies to the General Liability, Auto & Workers Compensation Coverage. Gen Liab is Primary & Non Contributory. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Salina THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 736 Salina, KS 67402-0736 AUTHORIZED REPRESENTATIVE Doris Pilatus/PILADO /.atQf /Z nj4 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) 'ACORO i DATE IMM DD YY Y).. CERTIFICATE OF LIABILITY INSURANCE :'-f.'�%� _ .-. - - - -•-" -' •- 12/6/201. . ' ITHIS-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&Ugh endorsement(s). -= PRODUCER CONTACT Doris Pi latus • ' &.c.r.:rr7..„_...:2.2 NAME: - __. _. ._.. - - _ - _BLCPHONNE9 ,Edtt' (785)625-560 - ------ �-Sn3urdnCe'Plannin "Inc.""^_ i .. .!. (AIC-NOB:(J85) 3006FBroadway Avenue-1;... I mins,: t_____-.__"2_1_''.21 • Pilado@insurance=planning.tom - -- .. P. '0:-7•1510X(.gIOO: •;u -- _ INSURER(S)AFFORDING COVERAGE -. - - . - --NAIC k---' INSURER A:Continental Western Insur Co..-- - . 10804--2— INSUREDI"-----'-" "' - --'- INSURER B:Riverport Insurance Company - - 36684. --- Nex-Tech Wireless LLC, -. INSURER C: • 3001 New Way INSURER O: • INSURER E: Hays KS 67601 INSURER F: COVERAGES • CERTIFICATE NUMBER:18/19 Certs REVISION NUMBER: I- THIS.IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD -1 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. ILTR I TYPE OF INSURANCEp fl ISWY➢� POLICY NUMBERI IMM LJCY EXP OD(YYYYI I(MEFF M!DDTYYYY)I LIMITS X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE I s 1,000,000 DAMAGE TO A I CLAIMS-MADE I X I OCCUR PREMISES(EaENTED occurrence) I5 600,000 RUP272175131 1/1/2018 1/1/2019 MED EXP(Arty ane person) IS . 5,000 ,a- - ---_-- - - - - . . PERSONAL.5 ADV INJURY ' I S— 1,;000,000. s• .GENbAGGREGATE LIMIT APPLIES PER: I ' • .. GENERAL AGGREGATE -- I$ --4±-1,000,000 X ItoLICYsI I PRO LOC • . - - - - -- PRODUCTS-COMP/OPAGG I'S— 2,000,000 _' ._ ... ._ Employee Benefits - ,1.5__. _.1,000,000 )AUTOMOBILE UABWTY " - I CEOMBIINEED1SINGLE LIMIT_ „15 :L1,000,000. A N} X •ANY AUTO L -- - - - acacIen . ._ BODILY INJURY(Per person)•.I S ALLOWEDSCHEDULED RUP272175131 - 1/1/2018 1/1/2019 BODILY INJURY(PeravAenOI$ AUTOS AUTOS AUTOS " D PROPERTY DAMAGE S HIRED'AUTOS ,AUTOS (Per accident) t til-.il'�" I. I. _ _ .. - _ .. I - 5 . I.X UMBRELLA OAS •I OCCUR - ' EACH OCCURRENCE 5 10,000,000 A _ ' j: I :I,.,. .EXCESS UAB .- •I CLAIMS-MADE , ,. .. • AGGREGATE . S 10,000;600 .'t .•I.DED X I RETENTIONS s 0 - ROP272175131 • 1/1/2018 1/1/2019 - - - — - 'S WORKERS COMPENSATION .- .. . . , C. - ' - , AND EMPLOYERS LIABILITY '"•" Ir X I STATUTE EERH ANY•PROPRIETORIPARTNER/EXECUTIVE Y/N IE.L.EACH ACCIDENT ' 5- "' •1,000;000 OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) XSARP308556 9/15/2017 9/15/2018 I E.L.DISEASE-EA EMPLOYEE 5 1,000,000 IBI:rm ttaT.at,:.c __ _ _ __ -- - _ _ __ - • (DESCRIPTION OF OPERATIONS below I I I E.L.DISEASE-POLICY LIMIT 15 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached It more space Is required) RE:' Bicentennial Tower Salina KS 30 day notice is no longer applicable in KS. Certificate holder is an additional insured in regards to the Gen Liab & Auto Liability. Waiver of Subrogation applies to the General Liability, Auto & Workers Compensation Coverage. Gen Liab is Primary & Non Contributory. i • ,j CERTIFICATE HOLDER CANCELLATION - I I - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 'I City of Salina THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN I City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 736 Salina, KS 67402-0736 AUTHORIZED REPRESENTATNE I - Doris Pilatus/PILADO tco 4:6-27Y4 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) - ACO® CERTIFICATE OF LIABILITY INSURANCEDATE(MMIODIVYYY) ‘a....>"' . - 10/30/2017 " 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). , PRODUCER CONTACT Doris Pilatus • ' NAME: Insurance Planning Inc. _SHO NE No Extl: (785)625-5605 I IMc`ol: (785)625-8388 30064 Broadway Avenue- amiaess:pilado@insurance-planning.com - - - P. O. Box 100 INSURER(S)AFFORDING COVERAGE - NAZCA Hays - - KS 67601 INSURERA:Continental western Insur Co. 110804 . INSURED wsuRERe:Riverpor[ Insurance Company 36684. Nex-Tech Wireless LLC, INSURER C: I 3001 New Way INSURERD: INSURER E: I Hays KS 67601 INSURERF: I COVERAGES CERTIFICATE NUMBER:17/18 Certs /WC REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTOTHE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTVdTHSTANDING 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 rPOL,IICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR I TYPE OF INSURANCE ' R IN D'SWVQ POLICY NUMBER I(MMIDDIYEYYY) IMMIDDM'YY) LIMITS A IX I COMMERCIAL GENERAL LIABILITY • EACH OCCURRENCE 1 S 1,000,000 I CLAIMS-MADE I X I OCCUR - PREMI SET(ES( RENTEDEa occurrence) I S 600,000 RUP272175130 1/1/2017 1/1/2018 I MED EXP(My one person) 15 5,000 PERSONAL SADV INJURY $ 1,000,000 I GGEENL AGGREGATE LIMIT APPLIES PER'. GENERAL AGGREGATE $ 2,000,000 [ 1POLICY PRO ECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 I I OTHER'. - $ - ( j I.AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea acodent) , X ANY AUTO - I BODILY INJURY(Per person) $ A I' ALLOVtNED I IAUTOS SCHEDULED AUTOS RUP272175130 1/1/2017 1/1/2018 BODILY INJURY(Per a ident) $ X I HIRED AUTOS I X I AI ) UTO5KME0 (PeO RO YaDAMAGE S I . I I 5 I X I UMBRELLA LIAS I OCCUR" I EACH OCCURRENCE 5 10,000,000 A p EXCESS LAB I CLAIMS-MADE _ AGGREGATE 5 10,000,000 IDEO I X IRETENPONS OI RUP2]21]5130 1/1/2017 1/1/2018 5 WORKERS COMPENSATION - X I STANTE I 10TH - AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT 5 1,000,000" B OFFICER/MEMBER EXCLUDED? H/A _ _ _ EL JJ — 1,000,000 IDESCRIPsON O OrPERATIONS oel I I InSARP308555- • 9%15/201] 9/15/2018 I E.L.DISEASE-POLICY LIOITTEA EMPLYEt5 1,000,000 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached II more space is required) RE: Bicentennial Tower Salina KS 30 day notice is no longer applicable in KS. Certificate holder is an additional insured in regards to the Gen Liab & Auto Liability. Waiver of Subrogation applies to the General Liability, Auto & Workers Compensation Coverage. Gen Liab is Primary & Non Contributory. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Salina THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 736 — Salina, KS 67402-0736 AUTHORIZED REPRESENTATIVE /�J Doris Pilatus/PILADO �u4 /i latiri4 1988-2014.ACORD CORP.ORATION.-All rights-reserved.—- - ACORD 25(2014101)- -- —, - —The ACORD name and logo are registered marks of ACORD INS025(2o1eo1) B I BerkleyNet Kansas Workers' Compensation Insurance Plan Riverport Insurance Co I NCCI Carrier Code 27995 I a Berkley Company Administered by BerkleyNet Assigned Risk WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT Policy Number: KSARP308556 Tax ID#: 20.1189456 NEX-TECH WIRELESS LLC Policy Period: From: 09/15/2017 3001 NEW WAY To: 09/15/2018 HAYS, KS 67601-3262 Endorsement Date 09/15/2017 Date of Mailing: 11/06/2017 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Waiver Holder Name DBA City of Salina Comments All other terms and conditions of this policy remain unchanged. • Agency Name and Address Insurance Planning Inc PO Box 100 Hays, KS 67601-0100 WC 00 03 13 P.O.Box 591431 Minneapolis,Minnesota 55459-01431 Toll Free(888)548-7431 1 Fax(866)215-8118 www.berkleyassignedrisk.com 1 assignedrisk@berkleynet.com AC�® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 12/21/2015 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). PRODUCER CONTACT Doris Pilatus NAME: Insurance Planning Inc. PHONE/ No,Ext): (785)625 5605 `AC No): (785)625-8388 3006 Broadway Avenue VMss:pilado @insurance-planning.com P. O. Box 100 INSURER(S)AFFORDING COVERAGE NAIC# Hays KS 67601 INSURERA:COntinental Western Insur Co. 10804 INSURED INSURER B:Union Insurance Company — _ 25844 Nex-Tech Wireless LLC, INSURERC: 3001 New Way INSURERD: INSURER E Hays KS 67601 INSURERF: COVERAGES CERTIFICATE NUMBER:16/17 Certs 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! 'ADDLISUBR POLICY EFF I—POLICY EXP LTR TYPE OF INSURANCE INSD 1 WVD I POLICY NUMBER (MM/DD/YYYY)I(MM/DD/YYYY)J LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE PREMISES occurrence"A j CLAIMS-MADE X OCCUR 600,000 —._ RUP272175129 1/1/2016 1/1/2017 MEDEXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY • 1 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 JECT PRO- I__...., -- , OTHER: Employee Benefits $ 1,000,000 COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $ 1,000,000 _(Ea accident) A i ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED RUP272175129 1/1/2016 1/1/2017 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS -(Per accident) _$ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED X RETENTION$ 0 RUP272175129 1/1/2016 1/1/2017 $ WORKERS COMPENSATION X O STATUTE ETH AND EMPLOYERS'LIABILITY — - - - •- ------- ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N N/A E.L.EACH ACCIDENT _ $ 1,000,000 OFFICER/MEMBER EXCLUDED? N B ,(Mandatory in NH) WCA3120047 1/1/2016 1/1/2017 E.L.DISEASE-EA EMPLOYE $ 1,000,000 if yes,describe under 1 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 I I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: Bicentennial Tower Salina KS 30 day notice is no longer applicable in KS. Certificate holder is an additional insured in regards to the Gen Liab & Auto Liability. Waiver of Subrogation applies to the General Liability, Auto & Workers Compensation Coverage. Gen Liab is Primary & Non Contributory. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Salina THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 736 Salina, KS 67402-0736 AUTHORIZED REPRESENTATIVE Doris Pilatus/PILADO clZ 4/6/ l ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) ACORD, CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDryryY) 12/20/2014 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 pollcy(les)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 CONTACT NAME: Insurance Planning, Inc. (PAIHHONNo En), 785.625.5605 Wc,Noy:785.625.8388 3006 Broadway Avenue EMAIL - --- ADDRESS: P. O. Box 100 PRODUCER _. CUSTOMER ID P: Hays, KS 67601 INSURER(S)AFFORDINO COVERAGE HNC// INSURED INSURER A: Continental Western Insur Co. 110804 Nex-Tech Wireless LLC INSURER B: Travelers IndmtyCo of America '25666 3001 New Way INSURER C: Hays, KS 67601 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 15/16 Certificates 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. INSRI TYPE OF INSURANCE ADDLISUBRI POLICY EFF POLICY EXP I LTA' INSR WVD POLICY NUMBER (MM!DD(YYY) (MMIDDIYYYY). LIMITS GENERAL LIABILITY RUP272175128 01/01/2015 01/01/2016' EACH OCCURRENCE S 1,000,000 ' X COMMERCIAL GENERAL LIABILITY PREMSF$(E,S p0.},mnm $ 300,000 CLAIMS-MADE X OCCUR MED EXP(Any one person( $ 5,000 A PERSONAL&ADM INJURY $ 1,000,000 _ GENERAL AGGREGATE r$ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,00.0,000 X POLICY PRO. —-- AUTOMOBILELABILITY - RUP27217512 01/01/2015 01/01/2016 COMBINED SINGLE LIMIT • X ANY AUTO 8'� (ENaBcident $ 1,000,000 I BODILY INJURY(Per person) S H.- ALL OWNED AUTOS -.. $ BODILY INJURY(Per accident) $ A SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per exidenn 'S X i NON-OWNED AUTOS j s $ UMBRELLA LIAB 1X 'OCCUR RUP272175128 01/01/2015 01/01/20161 EACH OCCURRENCE $ 10,000,000 A EXCESS LAB CLAIMS-MADE AGGREGATE $ 10,000,000 _ DEDUCTIBLE $ X RETENTION $ 0 $ WORMERS COMPENSATION HHUB9D2354511401/01/2015 01/01/2016 X I WC STATU- OTM. AND EMPLOYERS LIABNTY YIN ITOHY LIMITS ER ANY PROPRIMBER EXCLUDED' E.L.EACH ACCIDENT $ 1,000,000 B OFFICERrrEMBER EXCLUDED' NIA (Mandatory In NW E L DISEASE-EA EMPLOYEE.$ 1,000,000 D SCRIPTO meOPERATIONSOeIax E L DISEASE-POLICY LIMIT I$ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/V HICLE9 AW ACORD 10t,Additional Remarks Schedule,Ir more space Is required) RE: Bicentennial Tower Salina KS 30 day notice is no longer applicable in KS. Certificate holder is an additional insured in regards to the Gen Liab & Auto Liability. Waiver of Subrogation applies to the General Liability, Auto & workers Compensation Coverage. Gen Liab is Primary & Non Contributory. CERTIFICATE HOLDER CANCELLATION 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 City Clerk AUTHORIZED REPRESENTATIVE mate PO Box 736 Y Sallina, KS 67402-0736 Doris Pilatus/PILADO ®1988-2009 ACORD CORPORATION. An rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD ACORD AGENCY CUSTOMER ID: LOC#: ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED Insurance Planning, Inc. Nex-Tech Wireless LLC POLICY NUMBER Hays, KS 67601 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: ACORD Certificate of Liability Insurance Garage Liability INSR ADDL POUCY EFFECTIVE POLICY EXPIRATION LIMITS LTR INSRD POLICY NUMBER DATE IMMIDDIYYI DATE IMMNDPYYI AUTO ONLY•EA ACCIDENT $ ANY AUTO OTNERTXAN EA ACC $ AUTO ONLY. AGG $ Automobile Liability INSR ADOL POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD POLICY NUMBER DATE I MMIDDIYY) DATE IMMIDDIYYI A Excess/Umbrella Liability INSR ADOL POUCY EFFECTIVE POUCY EXPIRATION LTR INSRD POLICY NUMBER DATE(MMIDD/YY) DATE IMMIDDIVY) LIMITS A $ Other Liability INSR POLICY EFFECTIVE POLICY EXPIRATION LTR POLICY NUMBER DATE(MMIDOIYY) DATE(MMIDDFYY) LIMITS ACORD 101 (2008/01) ®2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD