Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Insurance
DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 07/14/2020 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). CONTACT PRODUCER Calli Roth NAME: FAX PHONE Assurance Partners, LLC(800) 563-1871(785) 825-5098 (A/C, No): (A/C, No, Ext): E-MAIL 201 E Iron Avenuecroth@yourassurance.com ADDRESS: P.O. Box 1213 INSURER(S) AFFORDING COVERAGENAIC # SalinaKS67402-1213Nationwide Mutual Insurance Company23787 INSURER A : INSURED Accident Fund General Insurance Company12304 INSURER B : Salina Scale Sales and Service, Inc.ACE Fire Underwriters Insurance Company20702 INSURER C : PO Box 3261 INSURER D : INSURER E : SalinaKS67402 INSURER F : 20.21 All Lines COVERAGESCERTIFICATE 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. ADDLSUBR INSRPOLICY EFFPOLICY EXP TYPE OF INSURANCELIMITS POLICY NUMBER LTR(MM/DD/YYYY)(MM/DD/YYYY) INSDWVD COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE$ DAMAGE TO RENTED 100,000 CLAIMS-MADEOCCUR$ PREMISES (Ea occurrence) 5,000 MED EXP (Any one person)$ AYYACP724226660807/20/202007/20/20211,000,000 PERSONAL & ADV INJURY$ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- 2,000,000 POLICYLOCPRODUCTS - COMP/OP AGG$ JECT $ OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY 1,000,000 $ (Ea accident) ANY AUTOBODILY INJURY (Per person)$ OWNEDSCHEDULED AYYACP724226660807/20/202007/20/2021 BODILY INJURY (Per accident)$ AUTOS ONLYAUTOS HIREDNON-OWNEDPROPERTY DAMAGE $ (Per accident) AUTOS ONLYAUTOS ONLY $ UMBRELLA LIAB 5,000,000 OCCUREACH OCCURRENCE$ A EXCESS LIAB ACP724226660807/20/202007/20/20215,000,000 CLAIMS-MADEAGGREGATE$ 0 DEDRETENTION$$ PEROTH- WORKERS COMPENSATION STATUTEER AND EMPLOYERS' LIABILITY Y / N 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT$ B N / A YWCV602190307/20/202007/20/2021 OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS belowE.L. DISEASE - POLICY LIMIT$ Ea Wrongful Act$500,000 Professional Liability CEONKSF14407625207/20/202007/20/2021Aggregate$500,000 Deductible $10,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CG7323, AC7004, WC000313 CERTIFICATE HOLDERCANCELLATION 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 Public Works/Landfill AUTHORIZED REPRESENTATIVE P.O. Box 736 SalinaKS67402-0736 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD COMMERCIAL AUTO AC 7004 03 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESSAUTO PROTECTION -PLUS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM SUMMARY OF COVERAGES A.Effect of This Endorsement B.Temporary Substitute Autos –Physical Damage Coverage C.Employees as Insureds –Nonowned Autos D.Additional Insured by Contract, Permit or Agreement E.Prejudgment Interest Coverage F.Personal Effects and Property of Others Extension G.Expanded Towing Coverage H.Expanded Transortation Expense I.Extra Expense –Stolen Autos J.Emergency Lockout K.Transfer Of Rights Of Recovery Against Others To Us L.Section IV –Business Auto Conditions -Notice of Knowledge of Occurrence AC 70 04 03 16 Includes copyrighted material of Insurance Services Office, Inc. Page 1 of 3 with its permission AC 70 04 03 16 orsignedbyyoupriortoa“bodilyinjury”or A.EFFECT OF THIS ENDORSEMENT “propertydamage”occurrenceisan“insured” Coverage provided under this policy is modified forCovered Autos LiabilityCoverage. by the provisions of this endorsement. If there However,withrespecttocovered“autos”, is any conflict between the provisions of this insuredonly suchpersonororganizationisan endorsement and the provision(s) of any state- totheextent thatpersonororganizationqualifies specific endorsement also attached to this poli- asan“insured”underA.1.WhoisanInsuredof cy, then the provision(s) of the state-specific SECTIONII–COVERED AUTOS LIABILITY endorsement shall apply instead of the provi- COVERAGE. sions of this endorsement that are in conflict, Ifspecificallyrequiredbythewrittencontract but only to the extent of the conflict, and only to oragreementreferencedintheparagraph the extent necessary to bring such provisions providedbythisen- above,anycoverage into conformance with the state requirement(s) dorsementtoanadditionalinsuredshallbe contained in the provision(s) of the state-specific primaryandanyothervalidandcollectible endorsement. insuranceavailabletotheadditionalinsured B.TEMPORARY SUBSTITUTE AUTOS – shallbenon-contributorywiththisinsurance.If thewrittencontractdoesnotrequirethiscov- PHYSICAL DAMAGE COVERAGE eragetobeprimary andtheadditionalin- The following is added to paragraph C. Certain sured’scoveragetobenon-contributory,then Trailers, Mobile Equipment And Temporary thisinsurancewillbeexcessoveranyotherval- Substitute Autos of the –COVERED AUTOS idandcollectibleinsuranceavailabletothead- SECTION: ditionalinsured. If Physical Damage Coverage is provided by E.PREJUDGMENT INTEREST COVERAGE this Coverage Form, the following types of ThefollowingparagraphisaddedtoSECTIONII vehicles are also covered "autos" for Physi- -COVERED AUTOSLIABILITYCOVERAGE, cal Damage Coverage: SupplementaryPaymentsunderitem: Any "auto" you do not own while used with (7)Prejudgmentinterestawardedagainstthe the permission of its owner as a temporary “insured”onthatpartofthejudgmentwe substitute for a covered "auto" you own that pay.Ifwemakeanoffertopaytheappli- is out of service because of its: cablelimitofinsurance,wewillnotpay a. Breakdown; anyprejudgmentinterestbasedonthat periodoftimeaftertheoffer. b. Repair; F.PERSONAL EFFECTS AND PROPERTY OF c. Servicing; OTHERS EXTENSION d. "Loss"; or 1.The. Care, Custody or Control Exclusion of e. Destruction the SECTION II –COVERED AUTOS The coverage that applies is the same as LIABILITY COVERAGE,does not apply to the coverage provided for the vehicle being "property damage" to property, other than replaced. your property, up to an amount notexceed- C.EMPLOYEES AS INSUREDS –NONOWNED ing $250in any one "accident". Coverage AUTOS is excess over any other valid and collectible insurance. The following is added to paragraph A.1. Who Is An Insured of SECTION II –COVERED AUTOS 2.The following paragraph is added to.Cover- LIABILITY COVERAGE: age Extensionsof SECTION III – PHYSICAL DAMAGE COVERAGE: d.Any "employee" of yours is an "insured" while using a covered "auto" you don't own, c.We will pay up to $500 for your property hire or borrow in your business or your per- that islost or damagedas a result of a sonal affairs. covered “loss”, without applying a de- ductible.Coverage is excess over any D.ADDITIONAL INSURED BY CONTRACT, other valid and collectible insurance. PERMIT OR AGREEMENT G.EXPANDED TOWING COVERAGE ThefollowingisaddedtoA.1.WhoIsAn InsuredofSECTIONII–COVERED AUTOS 1.We will pay up to: LIABILITY COVERAGE: a.$100 for a covered "auto" you own of Anypersonororganizationthatyouare the private passenger type, or requiredtonameasanadditionalinsuredina agreementthatisexecuted writtencontractor Page 2 of 3 Includes copyrighted material of Insurance Services Office, Inc. AC 70 04 03 16 with its permission AC 70 04 03 16 b.$250 for a covered "auto" you own that orstolenandyouhavechangedthe is not of the private passenger type, locktopreventanunauthorized entry;and for towing and labor costs incurred each 3.Originalcopiesofreceiptsforservicesof time the covered "auto" is disabled. alocksmithmustbeprovidedbefore However, the labor must be performed at reimbursementis payable. the place of disablement. 2.Thiscoverage applies only for an "auto" K.TRANSFER OF RIGHTS OF RECOVERY covered on this policy for Comprehensive or AGAINST OTHERS TO US Specified Causes of Loss Coverage and The following is added to theTransfer Of Rights Collision Coverages. Of Recovery Against Others To Us Condition: 3.Payment applies in addition to the otherwise We waive any right of recoverywe may applicable amount of each coverage you have against any person or organization to have on a covered “auto”. the extent required of you by a written con- H.EXPANDED TRANSPORTATION EXPENSE tract executed prior to any “accident” be- Paragraph A.4.a. of SECTION III -PHYSICAL cause of payments we make for damages DAMAGECOVERAGE SECTIONis replaced by under this coverage form. the following: L.NOTICE OF AND KNOWLEDGE OF We will pay up to $50 per day to a maximum of OCCURRENCE $1000 for temporary transportation expense in- SECTION IV –BUSINESS AUTO curred byyou because of the total theft of a CONDITIONS, Paragraph A isamended as covered "auto" of the private passenger type. follows: We will only pay for those covered "autos" for 6.NOTICEOFANDKNOWLEDGEOF which you carry Comprehensive or Specified OCCURRENCE Causes of Loss Coverage. We will pay for tem- porary transportation expenses incurred during a.YourobligationintheDutiesintheEvent the period beginning 48 hours after the theft and of Accident,Claim,SuitorLossCondi- ending, regardless of the policy's expiration, tionrelativetonotification require- when the covered "auto" is returned to useor we mentsappliesonlywhenthe“accident” pay for its "loss" or“loss”isknownto: I.EXTRA EXPENSE –STOLEN AUTOS (1)You,if youareanindividual; The following paragraph is added to Coverage (2)Apartner,if youareapartnership; Extensions. of SECTION III –PHYSICAL (3)Amember,ifyou area limitedliability DAMAGE COVERAGE: company;or c.We will pay for up to $5,000 for the expense (4)An executive officer or insurance of returning a stolen covered “auto” to you. manager, if you are a corporation. We will pay only for those covered “autos” b.Your obligation in the. Duties inthe Event for which you carry Comprehensive or Spec- ofAccident, Claim, Suit or Loss Condition ified Causes of Loss Coverage relativetoprovidinguswithdocuments J.EMERGENCY LOCKOUT –PRIVATE concerningaclaimor“suit”willnotbe PASSENGER VEHICLES breach consideredbreachedunlessthe Wewillreimburseyouupto$75forreasonable occursaftersuchclaim or“suit”isknown expenseincurredfortheservicesofalocksmith to: togainentryintoyourcovered“auto”ofthepri- (1)You,if youareanindividual; vate passengertype subjectto these provisions: (2)A partner, ifyouareapartnership; 1.Yourdoorkeyorkeyentrypadhas (3)Amember, ifyouarealimited beenlost,stolenorlockedinyour liabilitycompany;or covered“auto”andyou areunableto enter such “auto” ,or (4)Anexecutiveofficerorinsurance manager,if youareacorporation. 2.Yourkeyorkeyentrypadhasbeenlost AC 70 04 03 16 Includes copyrighted material of Insurance Services Office, Inc.,Page 3of 3 with its permission COMMERCIAL GENERAL LIABILITY CG 73 23 12 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS ENHANCEMENT PLUS ENDORSEMENT INCLUDING MEDICAL PAYMENTS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A.Lost Key CoverageD.Expanded Property Damage Coverage 1.Under Section I –Coverages, Coverage A 1.For the purposes of this endorsement only: Bodily Injury And Property Damage Section I –Coverages, Coverage A Liability,coverage is extended to include Bodily Injury And Property Damage the following: Liability, 2. Exclusions,Exclusion j. If a customer's master or grand key, Damage To Property isamended as follows: excluding electronic key card, is lost,a.Paragraphs (3),(5), and (6)are deleted damaged or stolenwhile in your care, in their entirety. custody or control we will pay the cost of b.Paragraph (4)is deleted in its entirety replacing the keys, including the master lock and replaced with: and all keys used in the same lock, the cost (4)Personal property in the care, of adjusting locks toaccept the new keys, or custody,or control of the insured: the cost toreplace the locks, whichever is (a)for storage or sale at premises less. you own, rent or occupy; or 2.Limit of Insurance –For the purposeof this (b)while being transported by any coverage the most we will pay is $10,000 aircraft, "auto" or watercraft per “occurrence”. owned or operated by or rented B.Voluntary Property Damage to orloaned to any insured. 1.Section I –Coverages, Coverage A Bodily c.Thecoverage provided by this Injury And Property Damage Liability, endorsement does not apply to coverage is extended to include the following: “property damage”: At your request, we will pay for “property (1)Arising out of the disappearance or damage” to property of others caused by you loss of use of personal property; or andwhile in your possession, arising out of your (2)Included in the “products-completed business operations and occurring during the operations hazard”. policy period. 2.Limit of Insurance -The most we will pay 2.Limit of Insurance –For the purpose of this for loss arising out of any one “occurrence” coveragethe most we will pay is $1,500per is $5,000. “occurrence”. 3.Deductible -Our obligation to pay for a C.Non-Owned Watercraft covered loss applies only to the amount of Under Section I –Coverages, Coverage A loss in excess of $250. Bodily Injury And Property Damage Liability, We will pay the deductible amount to effect 2. Exclusions,Exclusion g. Aircraft, Auto Or settlement of any claim or ”suit” and, upon WatercraftParagraph (2) (a)is replaced with: notification of this action having been taken, (a)Less than 51 feet long; and you shall promptly reimburse us for the deductible as has been paid by us. CG 73 23 12 16Includes copyrighted material of Insurance Services Office, Inc., Page 1of 5 with its permission. CG 73 23 12 16 This insurance is primary to any expanded d.All reasonable expenses incurred by the property damage coverage provided by a insured at our request to assist us in the separate endorsement attached to this investigation or defense of the claim or policy, and it will supplant any deductible in “suit”, including actual loss of earnings up to said endorsement $500 a day because of time off from work. E.Damage To Premises Rented To YouG.Newly Formed And Acquired Organizations 1.Under Section I –Coverages, Coverage A Under SECTION II –WHO IS AN INSURED Bodily Injury And Property Damage Paragraph 3.a.is replaced with: Liability, the last paragraph of 2. a.Coverage under this provision is afforded Exclusions is replaced with:th day after you acquire or only until the 180 If Damage To Premises Rented To Youis form the organization or the end of the policy not otherwise excluded, Exclusions c. period, whichever is earlier; through n.do not apply to damage by fire, H.Additional Insured –Automatic Status When lightning, explosion, smoke,or sprinkler Required In An Agreement Or Contract With leakage to premises while rented to you or You temporarily occupied by you with permission Section II –Who Is An Insuredis amended to of the owner. include: 2.Under Section III –Limits Of Insurance, 1.Any person(s) or organization(s) described Paragraph 6is replaced with: in Paragraph a. –d.below with whom you 6.Subject to 5.above, the Damage To have agreed in writing in acontract or Premises Rented To You Limit is the written agreement that such person or most we will pay under Coverage Afor organization be added as an additional damages because of “property damage” insured on your policy during the policy to any one premises, while rented to period shown in the Declarations. you, or in the case of damage by fire, 2.Any other person or organization you are lightning, explosion, smoke or sprinkler required to add as an additional insured leakage, while rented to you or under the contract or agreement described temporarily occupied by you with in Paragraph1.above. permission of the owner. The limit is The person or organization added as an increased to $1,000,000. insured by this endorsement is an insured 3.Under Section IV –Commercial General only for liability due to: Liability Conditions,4.Other Insurance, b. a.Lessors of Leased Equipment–with Excess Insurance (1) (a) (ii)is replaced respect to their liability for “bodily injury”, with: “property damage”, or “personal and (ii)That is Fire, Lightning, Explosion, Smoke advertising injury”, caused in whole or in or Sprinkler leakage insurance for part by yourmaintenance, operation,or premises rented to you or temporarily use of equipment leased to you by such occupied by you with permission of the person(s)or organization(s). This owner. insurance does not apply to any F.Supplementary Payments“occurrence” which takes place after the equipment lease expires. Under Section I –Coverages, Supplementary Payments –Coverages A and B Paragraphs However, their status as additional 1.b and 1.d.are replaced with:insured under this policy ends when their lease, contract,or agreement with b.Up to $2,500 for cost of bail bonds required you for such leased equipment expires. because of accidents or traffic law violations b.Managers or Lessors of Premises– arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. with respect to liability arising out ofthe We do not have to furnish these bonds.ownership, maintenance,or use of that part of the premises you own, rent, lease,or occupy. Includes copyrighted material of Insurance Services Office, Inc.,CG 73 23 12 16 Page 2 of 5 with its permission. CG 73 23 12 16 This insurance does not apply to:(1)Your acts or omissions; or (1)Any “occurrence” which takes place (2)The acts or omissions of those after you cease to be a tenant in acting on your behalf;in the performance of yourongoing that premises. operations performed for that (2)Structural alterations, new con- additional insured, whether the work struction,or demolition operations is performed by you or on your performed by or on behalf of the behalf. person or organization. The insurance does not apply to: However, their status as additional (1)“Bodily injury”, “property damage”, insured under this policy ends when you or “personal and advertising injury” cease to be a tenant of such premises. arising out of the rendering of or the c.State or Political Subdivision – failure to render any professional PermitsRelating to Premises–with architectural, engineering,or survey respect to the following hazardsfor services, including: which the state or political subdivision (a)The preparing, approving, or has issued a permitor authorization in failing to prepare or approve connection with premises you own, rent, maps, shop drawings, opinions, or control and to which this insurance reports, survey, field orders, applies. change orders,or drawings and (1)The existence, maintenance, repair, specifications;or construction, erection, or removal of (b)Supervisory, inspection, archi- advertising signs, awnings, tecturalor engineering activities. canopies, cellar entrances, coal holes, driveways, manholes, This exclusion applies even if marquees, hoist away openings, the claimsagainst any insured sidewalk vaults, street banners, or allege negligence orother decorations and similar exposures; wrongdoing in the supervision, or hiring, employment, training or monitoring of others by that (2)The construction, erection, or insured, ifthe “occurrence” removal of elevators; or which caused the“bodily injury” (3)The ownership maintenance or use or “property damage”, orthe of any elevators covered by this offense which caused the insurance. “personaland advertising This insurance does not apply to: injury”, involved therendering (1)“Bodily injury”or “property damage” of, or failure to render, any or “personal or advertising injury” professional, architectural, arising out of operations performed engineering,or surveying for the state or municipality; or services. (2)"Bodily injury" or "property damage" (2)“Bodily injury” or “property damage” occurring after: included within the “products- completed operations hazard”. (a)All work, including materials, parts,or equipment furnished in However, such state or political connection with such work, on subdivision’s status as additional the project (other than service, insured under this policy ends when the maintenance,or repairs) to be permit ends. performed by or on behalf of the d.Owners, Lessees, or Contractors– additional insured(s) at the with respect to liability for "bodily injury", location of the covered "property damage", or "personal and operations has been completed; advertising injury" caused in whole or in or part, by: Includes copyrighted material of Insurance Services Office, Inc.,Page 3 of 5 CG 73 23 12 16 with its permission. CG 73 23 12 16 (b)That portion of "your work" out b.You have agreed in writing in a contract of which the injury or damage or agreement that this insurance would arises has been put to its be primary and would not seek intended use by any person or contribution from any other insurance organization other than another available to the additional insured. contractor or subcontractor I.Employee Bodily Injury To Another Employee engaged in performing Under Section II –Who Is An InsuredThe operations for a principal as a followingis added to Paragraph 2.a.(1): part of the same project. Paragraphs2.a.(1)(a), (b) and (c) do not apply However, a person or organization’s to “bodily injury” to a co-“employee” in the status as additional insured under course of the co-“employee’s” employment by this policy ends when your you, or to “bodily injury” to a co-“volunteer operations for that additional insured worker” while performing duties related to the are completed. conduct of your business. With respect to the insurance afforded to J.BroadForm Named Insured such additional insureds a. –d.described above, the following is added to Section III Under Section II –Who Is An InsuredThe –Limits Of Insurance: followingis added toParagraph2.: If coverage provided to the additional e.Any business entity incorporated or insured is required by a contract or organized under the laws of the United State agreement, the most we will pay on behalf of of America (including any State thereof), its the additional insured is the amount of territories or possessions,or Canada insurance: (including any Province thereof) in which the 1.Required by the contract or agreement; Named Insured shown in the Declarations or owns, during the policy period, an interest of 2.Available under the applicable Limits of more than fifty percent. If other valid Insurance shown in the Declarations: collectible insurance is available to any business entity covered by this solely by whichever is less. reason of ownership by the Named Insured This endorsement shall not increase the shown in the Declarations in excess of fifty applicable Limits of Insurance shown in the percent, this insurance is excess over the Declarations. other insurance, whether primary, excess, However, the insurance afforded to such contingent, or on any other basis. additional insureds a. –d. described above: K.Aggregate Limit Per Location 1.Only applies to the extent permitted by law; andUnder Section III –Limits Of Insurancethe following is added to Paragraph 2: 2.Will not bebroader than that which you are required by the contract or TheGeneral Aggregate Limitunder Section III agreement to provide for such additional Limits Of Insuranceapplies separately to each insured. of your locationsowned by or rented to you or temporarily occupied by you with the permission 3.Primary and Noncontributory –Other Insurance Conditions of the owner. For the purposes of this provision, location means premises involving the same or The following is added to the Other connecting lots, or premises whose connection InsuranceCondition and supersedes any is interrupted only by a public street, roadway, provisions to the contrary: waterway or railroad right-of-way. Primary and Noncontributory Insurance L.Aggregate Limit Per Project This insurance is primary to and will not seek contribution from any other insuranceUnder Section III –Limits Of InsuranceThe available to an additional insured under your following paragraph is added to Paragraph 2: policy provided that: TheGeneral Aggregate Limitunder Section III a.The additional insured is a Named Limits Of Insuranceapplies separately to each Insured under such other insurance; and of your construction projects away from premises owned by or rented to you. Page 4 of 5 Includes copyrighted material of Insurance Services Office, Inc.,CG 73 23 12 16 with its permission. CG 73 23 12 16 M.Medical Payments inception date of the policy shall not prejudice the coverage afforded by this Under Section III –Limits Of Insurance, policy provided such failure to disclose all Paragraph 7. is replacedwith: hazards or prior “occurrences” or offenses is 7.Subject to 5.above, the higher of: not intentional. This provision does not a.$10,000; or affect our right to collect additional premium or exercise our right of cancellation or non- b.The amount shown in the Declarations renewal. for Medical Expense Limit is the most we will pay under CoverageCfor all P.Waiver Of Subrogation medical expenses because of “bodily Under Section IV –Commercial General injury” sustained by one person. Liability Conditions,8. Transfer Of Rights Of This coverage does not apply if Coverage C Recovery Against Others To Us the following –Medical Paymentsis excluded either by paragraph is added: the provisions of any coverage forms If required by a written contract executed prior to attached to the policy or by endorsement. loss, we waive any right of subrogation we may N.Knowledge Of An Occurrence have against the contracting person or organization because of payments we make for Under Section IV –Commercial General injury or damage arising out of your ongoing Liability Conditions,the following is added to operations or “your work” done under a contract 2.Duties InThe Event Of Occurrence, with that person or organization and included in Offense, Claim Or Suit: the “products-completed operations hazard”. e.Knowledge of an occurrence, offense, claim Q.Liberalization or suit by an agent or employee of any insured shall not in itself constitute Under Section IV –Commercial General knowledge of the insured unless you, a Liability Conditions,the following paragraph is partner, if you are a partnership; or an added: executive officer or insurance manager, if 10.Liberalization you are a corporation receives such notice If we revise this coverage form to provide more of an occurrence, offense, claim or suit from coverage without additional premium charge, the agent or employee. your policy will automaticallyprovide the f.The requirements in Paragraph b.will not additional coverage as of the day the revision is be considered breached unless there is effective in your state. knowledge of occurrence as outlined in R.Broadened Bodily Injury Definition (Mental Paragraph e. above. Anguish) O.Unintentional Failure To Disclose Hazard Under Section V –DefinitionsDefinition 3. Under Section IV –Commercial General “Bodily Injury” is replaced with: Liability Conditions,Condition 6. 3.“Bodily injury” means physical injury, Representationsthe following paragraph is sickness,or disease to a person and if added: arising out of the foregoing, mental anguish, d.Your failure to disclose all hazards or prior mental injury, shock,or humiliation, “occurrences” or offenses existing as of the including death at any time resulting therefrom. All terms and conditions of this policy apply unless modified by this endorsement. Includes copyrighted material of Insurance Services Office, Inc.,Page 5 of 5 CG 73 23 12 16 with its permission. XPSLFST!DPNQFOTBUJPO!BOE!FNQMPZFST!MJBCJMJUZ!JOTVSBODF!QPMJDZXD!11!14!24 )Fe/!5.95* XBJWFS!PG!PVS!SJHIU!UP!SFDPWFS!GSPN!PUIFST!FOEPSTFNFOU! Xf!ibwf!uif!sjhiu!up!sfdpwfs!pvs!qbznfout!gspn!bozpof!mjbcmf!gps!bo!jokvsz!dpwfsfe!cz!uijt!qpmjdz/!Xf!xjmm! opu!fogpsdf!pvs!sjhiu!bhbjotu!uif!qfstpo!ps!pshboj{bujpo!obnfe!jo!uif!Tdifevmf/!)Uijt!bhsffnfou!bqqmjft! pomz!up!uif!fyufou!uibu!zpv!qfsgpsn!xpsl!voefs!b!xsjuufo!dpousbdu!uibu!sfrvjsft!zpv!up!pcubjo!uijt! bhsffnfou!gspn!vt/* Uijt!bhsffnfou!tibmm!opu!pqfsbuf!ejsfdumz!ps!joejsfdumz!up!cfofgju!bozpof!opu!obnfe!jo!uif!Tdifevmf/ Tdifevmf Boz!qfstpo!ps!pshboj{bujpo!uibu!zpv!qfsgpsn!xpsl!gps!uibu!jt!mjbcmf!gps!bo!jokvsz-!dpwfsfe!cz!uijt!qpmjdz-!uibu! qsjps!up!uif!jokvsz!ibt!xsjuufo!dpousbdu!sfrvjsjoh!b!xbjwfs!pg!pvs!sjhiu!up!sfdpwfs!gspn!uifn/ This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. InsuredPremium $ Insurance CompanyCountersigned by XD!11!14!24 )Fe/!5.95*Copyright 1983 National Council on Compensation Insurance. • ACC7REP CERTIFICATE OF LIABILITY INSURANCE DATE (MMMenDO(I `) 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(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 Lindsey Stum NAME: Assurance Partners PHONE (800)563-1871 FAX (785 825-5098 AIC,No,Est): (A/C,Na): ) 201 E Iron Avenue EDorsLw: Istumtyourassurance.com P.O.Box 1213 INSURERISI AFFORDING COVERAGE NAIC Salina KS 67402-1213INSURER A: Nationwide Mutual Insurance Company 23787 INSURED INSURER B: Accident Fund General Insurance Company 12304 Salina Scale Sales and Service,Inc. INSURER G: ACE Fire Underwriters Insurance Company 20702 PO Box 3261 INSURER D INSURER E: Salina KS 67402 INSURER F: COVERAGES CERTIFICATE NUMBER: 19.20 All Lines 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 AUOLSUtiH POLJCPEFF POJCY tJ(P LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMDDIYYYY) (IAWDD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE 5 DAMAGc 10 RCN(XD 100,000 CLAIMS-MADE X OCCUR PREMISES(Ea ocamercx) S MED EXP(Any operson) $ 5.000 re A Y Y ACP7232266608 07/20/2019 07/2012020 PERSONAL&ADV INJURY $ 1.00D•000 GENLAGGREGATELIMIT APPLIES PER: GENERAL AGGREGATE S 2.000.000 POLICY n JECi n LOCPRODUCTS-COMP/OP AGO $ 2,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident/ X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED Y Y ACP7232266608 07/20/2019 07/20/2020 BODILY INJURY(Per accident) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY AUTOS ONLY (Per accident) ' S X UMBRELLA UAB X OCCUR EACH OCCURRENCE 5 5.000.000 A EXCESSIJAB CLAIMS-MADE ACP7232266608 07/20/2019 07/20/2020 AGGREGATE $ 5,000.000 DED X RETENTION S 0 WORKERS COMPENSATIONPER OTH- AND EMPLOYERS'LIABILITY X STATUTE ER YIN 1,000.000 B ANY PROPRIETOR/PARTNER/EXECUTNEF�I NIA Y t/VCV6021903 07/20/2019 07202020 EL EACH ACCIDENT 5 OFFICER/MEMBER EXCLUDED'! I ! (Mandatory inin NH) EL DISEASE.EA EMPLOYEE S 1.000.000 It Yee describe under 1.000.000 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT S Ea WrongfulAct 5500,000 Professional Liability C Deductible 510,000 EONKSF144076252 07/20/2019 07/20/2020 Aggregate 5500,000 DESCRIPTION OF OPERATIONS'LOCATIONS I VEHICLES(ACORD WI.Additional Remarks Schedule,may be attached if more space Is required) CG7323,AC7004,1NC000313 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/Landfill P.O.Box 736 AUTHORIZED REPRESENTATIVE �7 Salina KS 67402-0736 lV IY�, 4a.L ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MM DD OYY) `f 07/05/2018 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Susan Flaming NAME: Assurance Partners PHONE (800)563-1871 FAX85 825-5098 (A/C,No.Ertl: (NC,No): ) 201 E Iron Avenue E-MAIL sflaming@yourassurance.com ADDRESS: g� P.O.Box 1213 INSURERS)AFFORDING COVERAGE NAIC s Salina KS 67402-1213INSURERA: Nationwide Mutual Insurance Company 23787 INSURED INSURER B: Accident Fund General Insurance Company 12304 Salina Scale Sales and Service,Inc. INSURER C: RT Specialty,LLC PO Box 3261 INSURER D: INSURER E: Salina KS 67402-3261 INSURER F: COVERAGES CERTIFICATE NUMBER: 18.19 All Lines REVISION NUMBER: THIS 15 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD I INDICATED. NOT`MTHSTANDING 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 INSD WVD POLICY NUMBER (MMIDD/YYYY) (MMIDDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE 5 CLAIMS-MADE X OCCUR DAMAGE,O REN I'LD 100,000 PREMISES(Ea occurrence) 5 MED EXP(Arty one person) 5 5,000 A Y Y ACP7222266608 07/20/2018 07/20/2019 PERSONAL ADV INJURY 5 1.000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 5 2.000,000 POLICY n PRO 2,000,000 JECT LOC PRODUCTS-COMPIOP AGG 5 OTHER: 5 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per pers(m) 5 A OWNED SCHEDULED Y Y ACP7222266608 07/20/2018 07/20/2019 BODILY INJURY(Per accident) 5 AUTOS ONLY AUTOS X AUTOS ONLY X AUTOS ONLY (PeOxad DAMAGE 5 5 • X UMBRELLA UAB X OCCUR EACH OCCURRENCE 5 5,000,000 1 A EXCESS UABcwMSMAOE ACP7222266608 07/20/2018 07/20/2019 AGGREGATE S 5,000,000 DED X RETENTION s 0 s WORKERS COMPENSATION X PER 0TH- AND EMPLOYERS UABIUTY YIN STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE I NIA Y WCV6021903 07/20/2018 07/20/2019 E.L.EACH ACCIDENT 5 1.000,000 piOFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE 5 1000.000 If yes.desoibe under 1,000,000 DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY UNIT 5 • Ea Wrongful Act $500,000 Professional Liability C Deductible S10,000 EONKSF144076252 07/20/2018 07/20/2019 Aggregate 5500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CG7323.AC7004.W0000313 - 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/Landfill P.O.Box 736 AUTHORIZED REPRESENTATIVE Salina KS 67402-0736 �-01�.� . ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD • AC ORE) CERTIFICATE OF LIABILITY INSURANCE ;A�si2ol"4") 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 Roberta Blair NAME: Assurance Partners /MIL Fxtr (800)563-1871 (ac.Nor:(785)825-5098 201 E Iron St. MAFIIEs s:rblair®yourassurance.com P.O. Box 1213 INSURER(S)AFFORDING COVERAGE NAIC# Salina KS 67402-1213 INSURERANationWide Mutual Insurance Co 23787 INSURED INSURER B:Accident Fund General 12304 Salina Scale Sales and Service, Inc. INSURER C:Landmark American Ins. Co. PO Box 3261 INSURER D: INSURER E: Salina KS 67402-3261 INSURERF: COVERAGES CERTIFICATE NUMBER:14.15 All Lines 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 ADDLISUBR POLICY EFF POLICY EXP LIMITS LTR_ INSR�I WVD POLICY NUMBER IMM/DD/YYYY) (MM/DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ A CLAIMS-MADE X OCCUR X Y ACP7282266608 7/20/2014 7/20/2015 MED EXP(Any one person) $ 5,000 PERSONAL 8,ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 —1 POLICY I - I JECT PRO- n LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) g 1,000,000 A X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED x y ACP7282266608 7/20/2014 7/20/2015 BODILY INJURY(Per accident) $ AUTOS AUTOS X X NON-OWNED PROPERTY DAMAGE HIRED AUTOS _ AUTOS (Per accident) $ X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,000 ^— A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DED X RETENTION$ 0 ACP7282266608 7/20/2014 7/20/2015 B WORKERS COMPENSATION Y X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? WCV6021903 7/20/2014 7/20/2015 '(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under -- -DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 C Professional Liability LHR740149 7/20/2014 7/20/2015 Ea.Wrongful Act $500,000 $10,000 Deductible Aggregate $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) City of Salina, its agents, representatives, officers, officials and employees are named as additional insureds to general liability and auto liability. General liability is primary and non-contributory and includes completed operations. Waiver of subrogation is also included for general liability, auto liability and workers' compensation as allowed by state statute. 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 City of Salina ACCORDANCE WITH THE POLICY PROVISIONS. Public Works/Landfill P.O. Box 736 AUTHORIZED REPRESENTATIVE Salina, KS 67402-0736 �. Susan Flaming/SFLAMI � ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INSD25 mmnns)m The A(:(1Rrl namo anti Inn"arc rcnictorod marke"f Arnon