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Insurance Certificate
DATE(MM/DD/YYYY) ACC?" CERTIFICATE OF LIABILITY INSURANCE 04/18/2014 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(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 CA#OH64724 1-913-982-3650 CONTACT NAME: IMA, Inc. (NE Kansas Division) PHONE FAX A/C No Ext: A/C No: 913-982-3495 51 Corporate Woods E-MAIL ADDRESS: 9393 W. 110th Street, Suite 600 Overland Park, KS 66210 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: TRAVELERS IND CO OF AMER 25666 INSURED INSURER B: TRAVELERS IND CO OF CT 25682 Larson Construction, Inc. INSURER C TRAVELERS IND CO 25658 919 S Manhattan Ave INSURER D: CHARTER OAK FIRE INS CO 25615 PO Box 1411 Manhattan, KS 66505-1411 INSURER E7 INSURER F: COVERAGES CERTIFICATE NUMBER: 39325147 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A GENERAL LIABILITY DTC03919C633TIA14 04/30/1 04/30/15 EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED 300,000 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE � OCCUR MED EXP(Any one person) $ 5,000 X PD Ded: 2,500 1,000,000 PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X PRO- LOC $ JECT B AUTOMOBILE LIABILITY DT8103919C633TCT14 04/30/14 04/30/15 COMBINED SINGLE LIMIT 1,000,000 Ea accident $ X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident C X UMBRELLA LIAB X OCCUR DTSMCUP3919C633IND14 04/30/1 04/30/15 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED x RETENTION$10,000 1 1 $ D WC WORKERS COMPENSATION ,/N DTOUB3919C63314 04/30/1 04/30/15 X TORY LIMITS OER AND EMPLOYERS'LIABILITY � 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 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Re: K-143 Highway Utility Relocation, Project No. 13-2950 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 Department ACCORDANCE WITH THE POLICY PROVISIONS. 300 West Ash AUTHORIZED REPRESENTATIVE PO Box 736 Salina, KS 67402-0736 USA ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD schappel 39325147