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Insurance Certificate Client#: 9359 MIESCON ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE IMWmo/YYYY) 4/04/2019 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 have ADDITIONAL INSURED provisions or 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER ITA CONCT IMA, Inc.-Wichita Division PHONE FAX PO Box 2992 IEMAIL E,t):316 267.9221 I(AIC,No): 316 266-6254 Wichita, KS 67201 ADDRESS: INSURERIS)AFFORDING COVERAGE NMC9 316 267-9221 INSURER A:National Fire Ins.Company of Hartford 20478 INSURED I INSURER B:Continental Insurance Company 35289 Mies Construction Inc Vallee g 1919 SW Blvd INSURER c: y or a Insurance Co. 20508 Wichita, KS 67213 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 'ADDL SUBR PODGY EFF POLICY EXP LTR TYPE OF INSURANCE INSR IWVD POLICY NUMBER (MMIDDIYI'YY)I(MWODI'YYYY) LIMITS A XI COMMERCIAL GENERAL LIABILITY C6057531986 04/07/2019 04/07/2026 EACH OW T pOIIRRENCE 51,000,000 Ep CLAIMS-MADE X OCCUR PAEMEaENoccimnce) 15500,000 XI PD Deductible 82,500 MEDEXP(Anyoneperson) I s15,000 PERSONAL&ADV INJURY 151,000,000 GEN_AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 1 52,000,000 —I POLICY X JECT LOC PRODUCTS-COMP/OP AGG 152,000,000 I OTHER: 5 C I AUTOMOBILE LIABILITY C6057531972 04/07/2019 04/07/2026(DED,MBBINLVINGLE LIMIT 1 51,000,000 I xI ANY AUTO BODILY INJURY(Per Person) 15 SOW ED SCHEDULED BODILY INJURY(Per accident)15 AUTOS ONLY AUTOS I XI AUTOS ONLY X =TN PPO�de DAMAGE 5 I I I I IS B I x UMBRELLA LIAB IX IOCCURI 06057531955 04/07/2019 04/07/2020 EACH OCCURRENCE 1510,000,000 I EXCESS LIAB I I CLAIMS-MADE AGGREGATE 1510,000,000 I I DED X RETENTION 510,000 1 15 A WORKERS COMPENSATION C6057531969 04/07/2019 04/07/2020 X STATUTE I PORN I AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YI N E.L.EACH ACCIDENT 151,000,000 OFFICER/MEMBER EXCLUDED? T N I N I A (Mandatory In NH) E L.DISEASE-EA EMPLOYEE!51,000,000 If yes desrnbe older _ _ DESCRIPTION OF OPERATIONS beim./ E .DISEASE-POLICY LIMIT 51,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached II more space is required) Re: Water Main Replacements, Phase V 2010 Project#10-2842D, KPWSLF Project#2629. Certificate Holder is included as Additional Insured on the General Liability Policy and on the Auto Liability Policy if required by written contract or agreement subject to the policy terms and conditions. A Waiver of Subrogation is provided in favor of Certificate Holder on the General Liability and Automobile Liability Policies if required by written contract or agreement subject to the policy terms and conditions. CERTIFICATE HOLDER CANCELLATION Cityof Salina SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Utilities Dept ACCORDANCE WITH THE POLICY PROVISIONS. 300 W Ash PO Box 736 AUTHORIZED REPRESENTATIVE Salina,KS 67402-0736 ©1988.2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S1500087/M1499802 LAE Client#: 9359 MIESCON ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 4/04/2019 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 have ADDITIONAL INSURED provisions or 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER ICONTACT IMA,Inc. -Wichita Division PN ONEFAX PO Box 2992 EMAINo.Eat):316 267.9221 I(AK,Noy 316 266-6254 L ADDRESS: Wichita,KS 67201 316 267-9221 INSURER(S)AFFORDING COVERAGE HAIL a I INSURER A:National Fire Ins.Company of Hartford 20478 INSURED INSURER B:Continental Insurance Company 35289 Mies Construction Inc ValleyForge Insurance Co. 20508 1919 SW Blvd INSURER c: Wichita,KS 67213 INSURERD: INSURER E: I INSURER F: COVERAGES CERTIFICATE NUMBER:-"- REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW -(AVE 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. LTR TYPE OF INSURANCE INSRL PND POLICY NUMBER UBR POIDDY EFF POLICY EXP LIMITS (MMuCY EFF)I(POLICY 17-- 1 COMMERCIAL GENERAL LIABILITY C6057531986 04/0712019 04/07/2026EACH GGOCCURRENCE 51,000,000 I I CLAIMS-MADE X OCCUR RRE ?Ea acnsErrence) I s 500,000 X PD Deductible 52,500 MED EXP(Any one person) 515,000 PERSONAL a ADV INJURY 51,000,000 GEN.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 152,000,000 - POLICY X JECTT Iri LOC OTHER: PRODUCTS•COMP/OP AGO 1$2,000,000 15 • C AUTOMOBILE LIABILITY C6057531972 04/0712019 04/07/2020°O{EaM8INEDS10,000,000 LIMIT 1,000,000 NZ): X ANY AUTO r�� BODILY INJURY(Per person) I$ .I OWNED WN ONLY Ir�;;III SCHEDULED BODILY INJURY(Per accident)I$ I AI AUTOS ONLY I A I NON-OV.NELY O PROPERTY DAMAGE (Per acddent) I S _AUTOS ON I 1 I I - I5 B I XI UMBRELLA LIAB I X I OCCUR C6057531955 04/07/2019 04/07/2026 EACH OCCURRENCE 1510,000,000 I I EXCESS LIAB I CLAIMS-MADE AGGREGATE 1510,000,000 I I DED XI RETENTION 510,000 IS WORKERS COMPENSATIONMUTE C6057531969 04/07/2019 04/07/2026 X STATUTE FR AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT 1$1,000,000 OFFICERIMEMBER EXCLUDED? 1� NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE!$1,000,000 — If yes.desmbe under _ I DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT I$1,000,000 _ _ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ALORO 101,Additional Remarks Schedule,may be attached If more space Is required) RE:South Ohio Street Water&Sanitary Sewer Extension, Salina, KS. Certificate Holder is included as Additional Insured on the General Liability and Automobile Liability l,•=- /"-1; policies, if required by written contract or agreement,subject to the policy tertnsrand'conditions ?! q T� 11, a x c ?`1i ,.1W L t C 3 .` F. :. `1•. A 7--; 0 j/ r» . q �. CERTIFICATE HOLDER CANCELLATION Cityof Salina SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 300 W Ash St ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 736 Salina, KS 67402-0736 AUTHORIZED REPRESENTATIVE I -er—a.'tea... ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S1500086/M1499802 LAE Client#: 9359 MIESCON ACORDW CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 4/05/2018 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 have ADDITIONAL INSURED provisions or 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: IMA,Inc. -Wichita Division PHONE FAx (A/C,No,Est):316 267-9221 lac,No); 316 266-6254 PO Box 2992 E-MAIL Wichita, KS 67201 ADDRESS: INSURER(S)AFFORDING COVERAGE NAJC it 316 267-9221 INSURER A:Habana!FireIns.Ce npany or Hanford 20478 INSURED INSURER B:candnawl Nsannoa caravan 135289 Mies Construction Inc 1919 SW Blvd INSURER C Wichita, KS 67213 INSURER D: I INSURER E: INSURER F: I 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. LTR TYPE OF INSURANCE NSR SUBR WND POLICY NUMBER POLICY EFF POLICY EXP OMITS (MOLIClYEFF (POLICY I A X COMMERCIAL GENERAL LIABILITY PMT6057531986 04/07/2018 04/07/2014 EACH OCCURRENCE Si 000,000 CLAIMS-MADE X OCCUR I PEpREMISESO aENTED VR) 5500,000 X PD Deductible $2,500 MED EXP(Any we person) 515,000 PERSONAL B ADV INJURY $1,000,000 GEM-AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s2,000,000 POLICY I III JELT LOC PRODUCTS-COMP/OPAGG 52,000,000 OTHER: I IS AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT B BUA6057531972 04/07/2018 04I07I20191Eaacaam) 151,000,000 X ANY AUTO I BODILY INJURY(Per person) $ OWNED SCHEDULED BODILYINJURY(Per accident) $ AUTOS ONLY AUTOS X AUTOS ONLY X AUTOSNON-OONED LY PROPERTY DAMAGE 5 _ AUTOS ONLY (Per accident) ■■■■ 5 B )( UMBRELLA UAB X I OCCUR CUE6057531955 04/07/2018 04/07/2019 EACH OCCURRENCE $10,000,000 EXCESS LIAB I CLAIMS-MADE AGGREGATE -I ,510 000,000 DED I X RETENTION 510,000 Is A WORKERS COMPENSATION WC6057531969 04/07/2018 04/07/2019 X ISTATLTE IFORH 1 AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT 151,000,000 OFFICER/MEMBER EXCLUDED? N NIA (Mandatory In NH) I E L.DISEASE-EA EMPLOYEE/$1,000,000 2474H es.PaIPTIOsmde under —-_._ DESCRIPTION OF OPERATIONS below I E L.DISEASE-POUCH LIMIT-I 51,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD WI,Additional Remarks Schedule.may he attached II more space is required) RE: South Ohio Street Water&Sanitary Sewer Extension,Salina, KS. Certificate Holder is included as Additional Insured on the General Liability and Automobile Liability policies, if required by written contract or agreement, subject to the policy terms and conditions. CERTIFICATE HOLDER CANCELLATION Ciof Salina SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 300 W Ash St ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 736 Salina, KS 67402-0736 AUTHORIZED REPRESENTATWE I ,e—a �t ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S1416954/M1416827 LAE Client#:9359 MIESCON ACORDT. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDFYYYY) 410512018 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 have ADDITIONAL INSURED provisions or 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: IMA,Inc. -Wichita Division PHONE 316 267-9221 FAX 266-6254 PO Box 2992 EMAIL Eat): (AIL,No): Wichita, KS 67201 ADDRESS: INSURERIS)AFFORDING COVERAGE I NAM 316 267-9221 INSURER A:Macao!Fut Im.Coma y of Harvard 120478 INSURED INSURER B:Centintaal Insuranat Company 35289 Mies Construction Inc INSURER C 1 1919 SW Blvd Wichita, KS 67213 INSURER D: 1 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 'ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IINSR IWyD I POLICY NUMBER (MMIDD/YYYY) (MMIDDIYYYY)I LIMITS A X COMMERCIAL GENERAL LIABILITY PMT6057531986 04/07/2018 04/07/2019 EACH OCCURRENCE 51,000,000 CWMS-MADE X OCCUR I PREMISES(EaoNommence) 5500,000 X PD Deductible 52,500 MED EXP(Any one person) 1 s15,000 PERSONAL 8 ADV INJURY S1,000,000 GENL AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE 1 S2,000,000 PRO- POLICY X JECT LOC IPRODUCTS-COMP/OP AGG 52,000,000 OTHER: I S B AUTOMOBILE LIABILITY BUA6057531972 04107/201804/07/2019 comBINEDSINGLE LIMY 1,000,000 {Ea acvden0 1 5 X ANY AUTO I BODILY INJURY(Per person) 15 AUTOS SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X AUTOS ONLY X AUT OW NLY PROPERTY DAMAGE S AUTOS ONLY (Per accident) I Li 5 B x UMBRELLA UAB j( I OCCUR CUE6057531955 04/07/2018 04/07/2019 EACH OCCURRENCE $10,000,000 EXCESS MB I CLAIMS-MADE AGGREGATE 510,000,000 DED I X RETENTION 510,000 I $ A WORKERS COMPENSATION WC6057531969 04/07/2018 04/07/2019'X ISTATUTE INI-1 AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN I E.L.EACH ACCIDENT 151,000,000 OFFICERRAEMBER EXCLUDED/ I� N IA (Mandatory in NH) I E.L.DISEASE-EA EMPLOYEE 51,000,000 - — __._ I1yes.desc ibe under_ _ DESCRIPTION OF OPERATIONS belay I E.L:DISEASE-POLICY LIMIT 51,000,000 - —- DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule.may be attached it more space is required) Re:Water Main Replacements, Phase V 2010 Project#10-28420, KPWSLF Project#2629. Certificate Holder is included as Additional Insured on the General Liability Policy and on the Auto Liability Policy if required by written contract or agreement subject to the policy terms and conditions. A Waiver of Subrogation is provided in favor of Certificate Holder on the General Liability and Automobile Liability Policies if required by written contract or agreement subject to the policy terms and conditions. CERTIFICATE HOLDER CANCELLATION SHOULD City of Salina THE EXPIRATIONDATEDATE ABOVE THEREOF, NOTICEOCIELWILL CBE CDELIVEREDO IN Utilities Dept ACCORDANCE WITH THE POLICY PROVISIONS. 300 W Ash PO Box 736 AUTHORIZED REPRESENTATIVE Salina,KS 67402-0736 `" / ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) 1 of 1 The ACORD name and logo are registered marks of ACORD #51416955/M1416827 LAE • Client#:9359 MIESCON /YYYY) (MM/DD ACORDn. CERTIFICATE OF LIABILITY INSURANCE 4 DATE MIDDs 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 • NAME: IMA,Inc.-Wichita Division PHONE 316 267-9221 F"'t 316 266-6254 PO Box 2992 E-MAILo,Ezt). (A/c,No): Wichita, KS 67201 ADDRESS: 316 267-9221. INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Travelers Ind.Co.of America 25666 INSURED INSURER B:Travelers Indemnity Company 25658 Mies Construction Inc INSURER C: 1919 SW Blvd INSURER D: Wichita,KS 67213 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. LTR TYPE OF INSURANCE SRL,WVD POLICY NUMBER POLICY EFF POLICY EXP N LIMITS (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABIUTY DTCO9B956576TIA16 04/07/2016 04/07/2017 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR DAMAGE ISO(EaEoccccuE RENTED $300,000 X PD Ded:$2,500 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- POLICY X JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: _ $ A AUTOMOBILE LIABILITY . DT8109B956576TIA16 04/07/2016 04/07/2017 Ea OMBaccident)SI $INED NGLE LIMIT $1,000,000 ( X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) _ B X UMBRELLA UAB X OCCUR DTSMCUP9B956576IND 04/07/2016 04/07/2017 EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 DED X RETENTION$10,000 $ B WORKERS COMPENSATION DTKUB9B95657616 04/07/2016 04/07/2017 X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE' E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe.under ,-u• - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY=LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Re:Water Main Replacements, Phase V 2010 Project#10-2842D, KPWSLF Project#2629. Certificate Holder is included as Additional Insured on the General Liability Policy and on the Auto Liability Policy if required by written contract or agreement subject to the policy terms and conditions. A Waiver of Subrogation is provided in favor of Certificate Holder on the General Liability,Automobile Liability and Workers Compensation Policies if required by written contract or agreement subject to the (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION City of Salina SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Utilities Dept ACCORDANCE WITH THE POLICY PROVISIONS. 300 W Ash PO Box 736 AUTHORIZED REPRESENTATIVE Salina, KS 67402-0736 ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) 1 of 2 The ACORD name and logo are registered marks of ACORD #S1228398/M1228202 SLF2 • DESCRIPTIONS (Continued from Page 1) policy terms and conditions. SAGITTA 25.3(2014/01) 2 of 2 #S1228398/M1228202 • • Client#:93593 r - 17 - 112 J MIESCON ACORDn, CERTIFICATE OF LIABILIT URANCE DATE(MMIDDWYYY) - 3/21/2014 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 policy(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 I NAME: IMA, Inc.-Wichiita'Division I PHONE 316 267.9221 I P'� 316 266-6254 IAIC,Nq Ext): (AIC,No): PO Box 2992 E-MAIL ADDRESS: Wichita, KS 67201 INSURERISI AFFORDING COVERAGE I NAICl/ 316 267-9221 INSURER A Travelers Ind.Co. of America 125666 INSURED I INSURER B:Travelers Indemnity Company 25658 Mies Construction Inc INSURER C:The Phoenix Insurance Company 25623 1919 SW Blvd INSURER D: Wichita,KS 67213 INSURER E: I INSURER F: I 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 I MSB IWVD I POLICY NUMBER (MPVDD VEYYV)I(M OY I UNITS A GENERAL LIABILITY DTC09B956576TIA14 04/07/2014 04/07/2015 EACH OCCURRENCE 51,000,000 • Eo XI COMMERCIAL GENERAL LIABILITY I-PR MISES?EaE ante) s300,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) 510,000 • X PD Ded: 52;500' _ PERSONAL SADV INJURY 51,000,000 • , GENERAL AGGREGATE 52,000,000 GENL AGGREGATE pi fl GATE LIMIT APPLIES PER: _ - PRODUCTS-COMP/OP AGG 52,000,000 71 POLICY I 1 --: LOC - S FC. C COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY DT81096956576PHX14 04/07/2014 04/07/2015(Ea anadem) $1,000,000 X ANY BODILY INJURY(Per lerson) $ • ALL OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS PROPERTY DAMAGE X HIRED AUTOS X AUTOSWNED (Per accident) 5 I P $ B X UMBRELLA LIAB . X I OCCUR DTSMCUP9B956576IND 04/07/2014 04/07/2015 EACH OCCURRENCE 510,000,000 EXCESS LIAB I CLAIMS-MADE IAGGREGATE 510,000,000 DED I XI RETENTIONS510,000 I 5 B WORKERS COMPENSATION WC ST ivir IPA H-1 EMPLOYERS'LIABILRY DTKUB9695657614 04/07/2014 04/07/2015 X ITORY'IMITS I IFOR H- ANY PROPRIETORIPARTNER/EXECUTIVE YIN I El.EACH ACCIDENT 1 51,000,000 OFFICER/MEMBER EXCLUDED? N NIA (Mandatory In NH) . I E.L.DISEASE-EA EMPLOYEE 51,000.000 U yes,Sesvibe under I I DESCRIPTION OF OPERATIONS below I EL.DISEASE-POLICY LIMIT 1 51,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101.Additional Remarks Schedule.II more space Is required) Re:Water Main Replacements, Phase V 2010 Project#10-2842D, KPWSLF Project#2629. ' - Certificate Holder is included as Additional Insured on the General Liability Policy and on the Auto Liability Policy if required by written contract or agreement subject to the policy terms and conditions. A Waiver of Subrogation is provided in favor of Certificate Holder on the General Liability,Automobile - Liability and Workers Compensation Policies if required by written contract or agreement subject to the (See Attached Descriptions) . 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 Utilities Dept • ACCORDANCE WITH THE POLICY PROVSIONS. 300 W Ash PO Box 736 AUTHORIZED REPRESENTATIVE Salina, KS 67402-0736 ",lp� I WtS ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 2 The ACORD name and logo are registered marks of ACORD #S1006146/M1006025 MDY - •