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Insurance Certificate
ACORO CERTIFICATE OF LIABILITY INSURANCE DAA(" "°p""Y ‘..------ 12/18/2018 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT SilverStone Group PHONE Molly Harmon FAX 11516 Miracle Hills Drive JAIs,No_ExtJi 402-964-5598 I lac,NM:402-557-6325 _ Suite 100 AADDREOREss: mharm on©ssgi.com Omaha NE 68154 INSURER(S)AFFORDING COVERAGE NAICI INSURER A:Travelers Ind.Co.Of America 25666 INSURED 5761 INSURER B:Charter Oak Fire Ins.CO. 25615 Olsson, Inc. P.O. Box 84608 INSURER c:Travelers Property Casualty Co.of America 36161 402-474-6311 INSURER D:Phoenix Insurance Company 25623 Lincoln NE 68501 INSURER E:Ace American Insurance Co. INSURER F: COVERAGES CERTIFICATE NUMBER:917255536 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. II UBRI TYPE OF INSURANCE IINSp IS LTRWyp I POLICY NUMBER IIMWDDIIYYYYII IMMIDONEXP YYYI LIMITS A I X I COMMERCIAL GENERAL LIABILITY P-630-8D707154 1/1/2019 1/1/2020 EACH OCCURRENCE 51000,000 CLAIMS-MADE X OCCUR r DAMAGE TO RENTED PREMISES(Ea occurrence) $100,000 I MED EXP(Any one person) 5 5,000 Li PERSONAL 8 ADV INJURY 51,000,000 I GEN_AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 I POLICY I X I Ira LOC I PRODUCTS-COMP/OP AGG 52,000,000 I I OTHER: I S B I AUTOMOBILE LABILITY P-810-1E019141 1/1/2019 1/1/2020 COMBINED SINGLE LIMIT 51,000000 (Ea accident) I X I ANY AUTOBODILY INJURY(Per person) 5 OWNEDSCHEDULED BODILY INJURY(Per accident) 5 AUTOS ONLY I AUTOS I 1 x HIRED AUTOS ONLY I X I AUTOS ONLYY I(P r acrid DAMAGE 5 I I I I • I $ C I X I UMBRELLA UAB I X I OCCUR PSM-CUP-9H235899 1/1/2019 1/1/2020 EACH OCCURRENCE 510,000,000 I EXCESS UAB I I CLAIMS-MADE AGGREGATE 510,000,000 I I DED I I RETENTION S 5 D WORKERS COMPENSATION UB-9H987803-18-43 1/1/2019 1/1/2020 IX I PERTUTE I OTH- ANDEMPLOYERS'W1B11JTY y/N STAER ANYPROPRIETORIPARTNEFUEXECUTIVE I E.L.EACH ACCIDENT 51 000,000 OFFICER/MEMBEREXCLUDED? N j N/A (Mandatory in NH) EL.DISEASE-EA EMPLOYEE 51,000,000 If yes.describe Inds DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$1,000,000 E Professional Liab IyEON 625589993 006 1/1/2019 1/1/2020 PL Each Gam 55,000,000 Made- _ade- _ _- -- - PCAggregae —55,000,000— PL Ded Per Gam 5350,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule.may be attached U more space is required) All Carriers listed above have AM Best Ratings of A++XV. City of Salina,its agents,representatives,officers,officials,and employees are additional insureds for general liability and automobile liability if required by written contract executed prior to loss.Primary&noncontributory status is govemed by the terms&conditions of the insurance policies of all parties to the contract.Waiver of Subrogation applies for general liability,automobile liability,and workers'compensation if required by written contract executed prior to loss. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Salina ACCORDANCE WITH THE POLICY PROVISIONS. Public Works Department P.O. Box 736/300 W.Ash Street AUTHORI2EDREPRESENTATNE Salina KS 67402 412. 0-eac"" t_ I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD A�OR ®D DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 12/14/2015 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 NAME: Debi Dodson SilverStone Group (A/c.No.Ext):402.964.5412 FAX No):402.557.6325__ 11516 Miracle Hills Drive E-MAIL Suite 100 ADDREss:ddodson anssgi.com Omaha NE 68154 INSURER'S)AFFORDING COVERAGE NAIC#- INSURERA:Charter Oak Fire ins. . C •15__ _-- INSURED 5761 INSURER B:Travelers Property,&Cas Of Am 66161___ Olsson Associates, Inc. INSURER c:Travelers Indemnity Ins. Co. -__ 5658 P.O. Box 84608 INSURER D:Travelers Indemnity Company - 402-474-6311 Lincoln NE 68501 INSURER E:Ace American Insurance Co. INSURER F: COVERAGES CERTIFICATE NUMBER:262320512 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 I POLICY EFF ' POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER ,(MM/DD/YYYY) (MM/DD/YYYY) LIMITS C GENERAL LIABILITY P-630-8D707184 1/1/2016 1/1/2017 EACH OCCURRENCE 1 $1,000,000 t DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY I_PREMISES(Ea occurrence) $300,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $10,000 ' PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER I 'I. PRODUCTS-COMP/OP AGG $2,000,000 POLICY IX 1 PEf I 1 LOC $ A AUTOMOBILE LIABILITY P-810-1E019141 1/1/2016 1/1/2017 COMBINED SINGLE LIMI f (Ea accident) . $1_000,000 IX ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE 'IX ! HIRED AUTOS X AUTOS I '!,_(Per accident) $ B X UMBRELLA LIAB X PSM-CUP-1E019165 1/1/2016 1/1/2017 OCCUR EACH OCCURRENCE $9,000,000 EXCESS LIAB AGGREGATE 1$9,000,000 - -__ CLAIMS-MADE DED RETENTION$ I $ D WORKERS COMPENSATION PVYCNUB-8D98059 11/1/2016 1/1/2017 X ' WC STATU- 'OTH- AND EMPLOYERS'LIABILITY Y I N I TORY LIMITS . ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N NIA - --- -- ---- - (Mandatory in NH) E .DISEASE-EA EMPLOYEE' $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E .DISEASE-POLICY LIMIT i$1,000,000 E Professional Liability EON G25589993 1/1/2016 1/1/2017 PL Each Claim $5,000,000 Claims Made PL Aggregate $5,000,000 PL Ded Per Claim $350,000 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) All Carriers listed above have AM Best Ratings of A++XV. City of Salina, its agents, representatives, officers, officials, and employees are additional insureds for general liability and automobile liability if required by written contract executed prior to loss. Primary&noncontributory status is governed by the terms&conditions of the insurance policies of all parties to the contract. Waiver of Subrogation applies for general liability, automobile liability, and workers'compensation if required by written contract executed prior to loss. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Salina ACCORDANCE WITH THE POLICY PROVISIONS. Public Works Department P.O. Box 736/300 W.Ash Street AUTHORIZED REPRESENTATIVE Salina KS 67402 )) I�I.,, ' �'it ';1 , . '�I 'rr 0 11. - ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD • °"�IM�°°"A R CERTIFICATE OF LIABILITY INSURANCE 12)172014 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: II 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 °NAM.re: Jill Aldredge _ SilverStone Group INC x Enr402-964-5575 iu�,NmA02-557-6325 11516 Miracle Hills Drive E—MAIL sia Brea a ss corn Suite 100 9 © 9 Omaha NE 68154 INSURER(S)AFFORDING COVERAGE NAIL$ INSURER A:Charter Oak Fire Ins. Co. - .25615 INSURED 5761 INSURER a:Travelers Prooerty&Cas Of Am 36161 Olsson Associates, Inc. INSURERC Ar Amcriran InsuranrEL CO. P.O. Box 84608 INSURER D_ lndpmnity Inc Co. 25658 402-474-6311 Lincoln NE 68501 INSURER ETravelers Indemnity Comoany INSURER F'. COVERAGES CERTIFICATE NUMBER:879542528 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 ADM SOW ' POLICY EFF POLICY EXP Lill INSR MD POLICY NUMBER 1MMTDIYYYYI IMMIDDNYYY1 LIMITS D I GENERAL LIABILITY P-8304107071841N0-l5 1/1/2015 1/1/2016 EACH OCCURRENCE 81,000,000 1_, COMMERCIAL GENERAL LIABILITY (Ea 1 DAMAGE TO RENTED 5100,000 y_CLAIMS-MADE O OCCUR MED EXP(Any one person) I $5,000 ti PERSONAL&ADV INJURY S1,000.000 GENERAL AGGREGATE 52,000000 ■ GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGO $2000000 L POLICY % PRO LOC • S A 1 AUTOMOBILE LIABILITY P-010-1 E019141-COF-15 1/1/2015 X/1/2016 COMBINED SINGLE LIMIT 1Ea LY $1,000,000 IX ANY AUTO BODILY INJURY(Per person) •S ALL OWNED SCHEDULED BODILY INJURY(Per accident) S ' 'AUTOS IAUTOS NO W NED PROPERTY DAMAGE HIRED AUTOS Y AUT OS Ppccldenp 1E • _ •B X •UMBRELLA LAB X OCCUR 1 PSM-CUP-1E019165-TIL-15 1/1/2015 1/1/2016 'EACH OCCURRENCE -J$9,000,000 EXCESS LM6 CLAIMS-MADE AGGREGATE ' S • DED 'RETENTIONS ' $ E WORKERS COMPENSATION I PWWCKU&609B059-0.15 11/1/2015 1/1/2016 X VC STATU- , OTH- ANDEMPLOYERS'WBILITY TORY I IMITS ER OFFICERNEMBER EXCLUDED?ECVTrvE N N NIA' ELEACM ACCIDENT 51,000,000 /Mandatory In NN) • E .DISEASE-EA EMPLOYEE 31000 000 If ea deembe under C IDESCRIPTION OF OPERATIONS below I I E L DISEASE•POLICY LIMIT 51,000,000 Prof essional Liability i i EON 025589993 001 1/1/2015 1/1/2016 PL Each Claim $5,000,000 Claims Made ', PL Aggregate $5,000,000 PL Ded Per Claim $350,000 DESCRIPTION OF OPERAT ORSILOCATORS 1 VEHICLES'Attach ACORD 101,Additional Rands Schedule,If mots space I.required) All Carriers listed above have AM Best Ratings of A++XV. City of Salina, its agents, representatives,officers,officials,and employees are additional insureds for general liability and automobile liability if required by written contract executed prior to loss. Primary&noncontributory status is governed by the terms&conditions of the insurance policies of all parties to the contract.Waiver of Subrogation applies for general liability,automobile liability,and workers'compensation it required by written contract executed prior to loss. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Salina ACCORDANCE WITH THE POLICY PROVISIONS. Public Works Department P.O. Box 736/300 W.Ash Street AUTHORIZED REPRESENTATIVE Salina KS 67402 Uctibia (xI I ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD