Insurance Certificate �...41 GEIGE-1 OP ID: RX
AWRL CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYI')
ki....------- 10/27114
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 800-272-6771 CONTACT
Marquis Agency A&E Practice NAME:
900 Route 9 North,Suite 503 732-634-5379 a/c Nr o•Ext): FAX No):
Woodbridge,NJ 07095 E-MAIL
Regional Business Unit ADDRESS:
INSURER(S)AFFORDING COVERAGE NAIC#
INSURER A:Travelers Prop&Cas of Amer 25674
INSURED Geiger Gossen Campbell INSURER B:Travelers Indemnity Company 25658
Engineers, P.C.
2 Executive Boulevard,Ste 309 INSURER C:Alterra Excess and Surplus Ins 33189
Suffern, NY 10901 INSURER D:
INSURER E:
_ INSURER F:
COVERAGES CERTIFICATE NUMBER: 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 TYPE OF INSURANCE 'DDL SUER POLICY EFF POLICY EXP LIMITS
LTR I IINSR IlWD I POLICY NUMBER (MMIDDIYYVY) (MMIDDIYYY`n
GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000
A X COMMERCIAL GENERAL LIABILITY X X 680-18394661-TIL-14 10/11114 10111115 DAMAGE 7o RENTED 1,000,000
PREMISES(Ea occurrence) S
CLAIMS-MADE X OCCUR _ MED EXP(Any one person) S 10,000
PERSONAL&ADV INJURY S 1,000,000
- ••• • - - - E- • GENERAL AGGREGATE ' S - -2,000,000 ..•
' GEN'L AGGREGATE LIMIT APPLIES PER•' - PRODUCTS-COMP/OP AGG $•' 2,000,000 -• ••. I POLICY I Il I JECTT I I LOC - .. - ' 5 •
AUTOMOBILE LIABILITY • 'COMBINEDSINGLELIMIT 1,000,000
. . (Ea accident)
S
A ANY AUTO X X 680-1 B394661-TIL-14 10111114 10111/15 BODILY INJURY(Per person), S . ,,
• AUTOS AUTOS ALL OWNED SCHEDULED - BODILY INJURY(Per accident) S
- _——-
NON-OWNED • - PROPERTY DAMAGE S
X HIRED AUTOS X
AUTOS (Per accident)•X UMBRELLA LIAB X OCCUR EACH OCCURRENCE S - 3,000,000
B EXCESS LIAB CLAIMS-MADE X X CUP-1B398715-1 •47 . 10/11114 10111/15 AGGREGATE 5 3,000,000
• DED I I RETENTIONS S-
WORKERS COMPENSATION X ITORY LIMITS I I ER
AND EMPLOYERS'LIABILITY
B ANY PROPRIETOR/PARTNER/EXECUTIVE Y I N U B-3824T61-0-14 10111114 10111115__ E.L.EACH ACCIDENT S 1,000,000
-_ — OFFICERIMEMBER EXCLUDED? • — N/A------ - - - --
1 (Mandatory in NH) S E.L.DISEASE-EA EMPLOYEE 5 1,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000
C Prof Liability MAXA7PL0001164 10111114. 10/11115 Per Claim 5,000,000
Aggregate 5,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required)
Certificate holder and its agents, representatives,officers,officials and
employees are included as additional insured,where required by contract,
under the General,Auto and Umbrella Liability policies.A Waiver of. .
• Subrogation in favor of the same is also included.
CERTIFICATE HOLDER CANCELLATION • • -
CITYSAL •
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Salinas, Kansas THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
y ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 736
Salina, KS 67402
AUTHORIZED REPRESENTATIVE
0 1988-2010 ACORD CORPORATION. All rights reserved.
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