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Certificate of Insurance StateFarm STATE FARM 0 CYO. DATE OF NOTICE: SEP 05 2019 PO Box 853922 CODE: Richardson, 7X 75085-3922 7A AT1 26 A co UTILITIES 0093 NOTE: PLEASE NOTIFY STATE FARM AT THE CITY BOX SALINA DEPT ADDRESS LISTED AT THE TOP, LEFT CORNER SA 736 OF THIS PAGE REGARDING ANY CHANGE OF SALINA KS 67402 0736 ADDRESS INFORMATION. 11'I'I'IIID"1IIrII11IIiiILrI""'Il�l��l�I'Ill��"�'��II�I'I 0 8 • s ADDITIONAL§INSURED'S NOTICE OF COVERAGE' State Farm Mutual Automobile Insurance Company 034D-FAFSA NAMED INSURED: - POLICY NO: 063 3743-A22-16N COVERAGE: RE PEDROTTI INC YR/MAKE/MODEL: 2019 RAM PICKUP BI AND PD LIABILITY 5855 BEVERLY AVE STE A MIL VIN/CAMPER: 1C6SRFFT2KN608926 511000 DED.COMP. MISSION KS 66202-2609 AGENT NAME: JOHN.BURNS 57000 DED.COLL. AGENT PHONE: (913)780-5555 ENDORSEMENT NO: 60286) POLICY EFFECTIVE SEP 03 2019 UNTIL TERMINATED El POLICY MESSAGES: This policy shown above supersedes policy#0633743-16M. The policy includes a loss payable clause protecting the additional insureds interest in the described car to the extent of the insurance _ b provided and subject to all policy provisions.The additional insured will be given 10 days notice if the policy is terminated. Until such notice is provided,it shall be presumed that the required'renewal premiums have been paid. Theadditionalinsured must notify us within 10 daysof - - - -- g' any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. 0 N FRT StateFarm STATE FARM® DATE OF NOTICE: AUG 10 2018 PO Box 853922 Richardson, TX 75085-3922 CODE: 9A ATI 26 A 00 1243 0093 INOTE: PLEASE NOTIFY STATE FARM AT THE CITYPO BOX SALINA UTILITIES DEPT ADDRESS LISTED AT THE TOP, LEFT CORNER • SALNA KS6 67402-0736 OF THIS PAGE REGARDING AY CHANGE OF %'• • ADDRESS INFORMATION. IIIIIIIIII'PJlld'lllllllllll'II'IIIIIIIIII"111111"1111)1111 O s O ADbITIONAUINSURED'S NOTICE OF COVERAGE State Farm Mutual Automobile Insurance Company 034D-FAFSA NAMED INSURED: POLICY NO: 063 3743-A22-16L COVERAGE: RE PEDROTTI INC YR/MAKE/MODEL: 2012 FORD SPORT WG BI AND PD LIABILITY • 5855 BEVERLY AVE STE A VIN/CAMPER: 1FMHK8D89CGA56280 S t MIL 4 1 000 DED.COMP. n MISSION KS 66202-2609 AGENT NAME: JOHN BURNS S1000 DED.COLL. AGENT PHONE: (913)780-5555 ENDORSEMENT NO: 6028BJ POLICY EFFECTIVE JUL 25 2018 UNTIL TERMINATED io POLICY MESSAGES: This policy shown above supersedes policy#0633743-16K. The policy includes a loss payable clause protecting the additional insureds interest in the described car to the extent of the insurance o_ provided and subject to all policy provisions.The additional insured will be given 10 days notice if the policy is terminated. Until such notice • is provided,it shall be presumed that the required renewal premiums have been paid. The additionalInsuredmust notify us within-10 days of - - - - - - any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. Cl MT 7 StateFarm STATE FARM® 0 CrO. DATE OF NOTICE: AUG 10 2018 PO Box 853922 Richardson, TX 75085-3922 CODE: WA ATI 26 A %QM Loa UTILITIES OF 3ALINE UTILITIES DEPT NOTE: PLEASE NOTIFY STATE FARM AT THE BOX 736 ADDRESS LISTED AT THE TOP, LEFT CORNER SA SAUNA KS 67402-0736 OF THIS PAGE REGARDING ANY CHANGE OF ADDRESS INFORMATION. I1'111"11'1I1'1I'1111111111"II1'II1'i1111rfirlllfl"II11I'11111 8 8 9 w e o ADDITIONAL_INSURED'S NOTICE;OF COVERAGE State Farm Mutual Automobile Insurance Company 034D-FAFSA NAMED INSURED: POLICY NO: 078 0344-C13-16K COVERAGE: RE PEDROTTI INC YR/MAKE/MODEL: 2012 CHEVROLET PICKUP BI AND PD LIABILITY IL ▪ 5855 BEVERLY AVE STE A VIN/CAMPER: 1GCRKSE7XCZ226341 S1100o DED .COMP. 61 MISSION KS 66202-2609 AGENT NAME: JOHN BURNS 51000 DED.COLL. AGENT PHONE: (913)780-5555 ENDORSEMENT NO: 6028BJ POLICY EFFECTIVE JUL 25 2018 UNTIL TERMINATED si POLICY MESSAGES: This policy shown above supersedes policy#0780344-16J. The policy includes a loss payable clause protecting the additional insureds interest in the described car to the extent of the insurance provided and subject to all policy provisions.The additional insured will be given 10 days notice if the policy is terminated. Until such notice • is provided,it shall be presumed that the required renewal premiumshave been paid. The additional insured must notify us within-10 days of - -- e any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. 8 MT ] StateFarm STATE FARM® a. DATE OF NOTICE: JUL 24 2018 PO Box 953922 Richardson, TX 75085-3922 LL?LLL1 ��CODE: Ly� V All 26 A Wilariall C01221 0 01 ' 00,33 NOTE: PLEASE NOTIFY STATE FARM AT THE CITY OF SALINA UTILITIES DEPT INA 736 SAADDRESS LISTED AT THE TOP, LEFT CORNER LINA KS 67402-0736 OF THIS PAGE REGARDING ANY CHANGE OF ADDRESS INFORMATION. 11 1111111111IiiI'iliii1'll'I1i1iiiiliII"1.1111IIII11II'll1l 8 8 9 0 0 ADDITIONAL`,INSUREDS NOTICE OF COVERAGE State Farm Mutual Automobile Insurance Company 034D-FAFSA NAMED INSURED: POLICY NO: 063 3743-A22-16K COVERAGE: RE PEDROTTI INC YR/MAKE/MODEL: 2012 FORD SPORT WG BI AND PD LIABILITY . e 5855 BEVERLY AVE STE A VIN/CAMPER: 1FMHK8D89CGA56280 5 t MIL 51000 DED.COMP. MISSION KS 66202-2609 AGENT NAME: JOHN BURNS 51000 DED.LOLL. cis q AGENT PHONE: (913)780-5555 g ENDORSEMENT NO: 6028BJ POLICY EFFECTIVE JUL 16 2018 UNTIL TERMINATED si POLICY MESSAGES: This policy shown above supersedes policy#0633743-16J. The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance _'o_provided and subject to all policy provisions.The additional insured will be given 10 days notice if the policy is terminated. Until such notice m is provided,it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of • a any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. N FRT StateFM/ STATE FARM® ^Dli SJCt 9W1 1 DATE OF NOTICE: JUL 24 2018 PO Box 853922 Richardson, TX 75085-3922 I' L IJ CODE: L et' 0-1 . LLLJJJ 9A AT1 26 A A1222 UT UTILITIES UTILI CITY OF 3ALINE TIES DEPT NOTE: PLEASE NOTIFY STATE FARM AT THE INA 736 SALINAADDRESS LISTED AT THE TOP, LEFT CORNER ELp OF THIS PAGE REGARDING ANY CHANGE OF KS 67402 0736 ADDRESS INFORMATION. I'lIIIII'VIII'IIIIIII�tllllltl��ttllt��hl�ltll1"IIiIIIII'lIIIII y s ADDITIONAL INSURED'S NOTICE OF COVERAGE State Farm Mutual Automobile Insurance Company 034D-FAFSA NAMED INSURED: POLICY NO: 078 0344-C13-16J COVERAGE: RE PEDROTTI INC YR/MAKE/MODEL: 2012 CHEVROLET PICKUP BI AND PD LIABILITY '^ 5855 BEVERLY AVE STE A VIN/CAMPER: 1GCRKSE7XCZ226341 5 t MIL S10000E0.COMP. MISSION KS 66202-2609 AGENT NAME: JOHN BURNS 6 AGENT PHONE: 51000 DED.cou. $ ENDORSEMENT NO: 60288J0-5555 POLICY EFFECTIVE JUL 16 2018 UNTIL TERMINATED io POLICY MESSAGES: This policy shown above supersedes policy#0780344-161. 2 The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance ,'o provided and subject to all policyprovisions.The additional insured will be given 10 days notice it the policy is terminated. Until such notice m is provided,it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within to days of c any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. 8 N FRT A�® CERTIFICATE OF LIABILITY INSURANCE DTE(MWO5/1 6/2o Y Y) 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 CONTA, NAME: Peggy Farquhar Bukaty Property 6 Casualty Services Inc. ( NHOe Ext): (913) 951-2400 I FAX NO: 4601 College Blvd Ste 100 EA ORE55:pfarquhar@bukatyagency.com INSURER(S)AFFORDING COVERAGE NAIC 4 Leawood KS 66211 IN5uRERA:West American Insurance Company 44393 INSURED INSURER a:Ohio Casualty Insurance Company 24074 R. E. Pedrotti Company Inc INsuRERcAmerican Fire and Casualty Company , 24066 5855 Beverly Ave INsuRERo:Capitol Specialty Insurance Corp INSURER E: Mission KS 66202 INSURERF: COVERAGES CERTIFICATE NUMBER:2018 MASTER LIAR 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. IUCY EXP LTRR POLICY ADOCSUER TYPE OF INSURANCE IINSD}WO' POLICY NUMBER IMWDOIMWDDIIYYYY)I UMITS X COMMERCIAL GENERAL LIABILITY I I ' EACH OCCURRENCE I S 1,000,000 �DAMAGETO RENTED 1,000,000 A CLAIMS-MADE X OCCUR PREMISES-(Ea occurrence) 5 BKW55155801 6/1/2018 ' 6/1/2019 i MEDEXP(Any me person) $ 15,000 PERSONAL&ADV INJURY S 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: I , GENERAL AGGREGATE S 2,000,000 POLICY, X 7aDi I LOC 1 i �PRODUCTS-COMP/OP AGG i 5 2,000,000 OTHER: • i I I Expense MW Factors . $ AUTOMOBILE UABIUTY • COMBWED SINGLE LIMIT r S:ia (Ea_acer4J ' .ANY AUTO I BODILY INJURY(Per person) 5 —ALL OWNED SCHEDULED I I BODILY INJURY(Per acddent)' S AUTOS AUTOS ' NON-OHIRED AUTOS _AUTOS QED LIPmO DAMAGE 5 i 5 X • UMBRELLA UAB X OCCUR i I EACH OCCURRENCE $ 5,000,000 B EXCESS UAB CIAIMS4AADE, (AGGREGATE $ 5,000,000 1 DED , X RETENTIONS 10,0001 05055155801 6/1/2018 16/1/2019 I $ WORKERS COMPENSATION - 1 I X ! STATUTE r I ERH LI 'AND EMPLOYERS' ABIUTY - ANYPROPRIETOR/PARTNERIEXECUTIVE YIN I I EL EACH ACCIDENT ' 5 1,000,000 OFFICERJMEMBER EXCLUDED? N I,NIA' C '(Mandatory in NH) XWA55155801 6/1/2018 I 6/1/2019 I E.L.DISEASE-EA EMPLOYEE $ 1,000,000 1it DESCRIPTION 0ureter OPERATIONS below I . I E.L.DISEASE-POLICY LIMIT I$ 1,000,000 D ; PROFESSIONAL iSGC03854-05 10/3/2017 110/3/2018 BEACH ERRONEOUS ACT $2,000,000 AGGREGATE $2,000,000 I DESCRIPTION OF OPERATIONS I LOCATIONS(VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) PROJECT: SALINA KANSAS WTP WELL #5 6 BOOSTER RTU'S CITY OF SALINA KANSAS IS ADDITIONAL INSURED EXCLUDING WORKERS COMPENSATION, AS REQUIRED BY WRITTEN CONTRACT. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF SALINA KANSAS WTP THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 401 S 5TH STREET ACCORDANCE WITH THE POLICY PROVISIONS. SALINA, KS 67401 AUTHORIZED REPRESENTATIVE Peggy Farquhar/PEGGY -. - y.� — ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) DATE(MM/DD/YYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE 6/2/2016 (MWDDr 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 Sandra Morby Mo NAME: Y Bukaty Property & Casualty Services Inc. PH NI o Ezt): (913)951-2400 I rtt,No): (913)345-2608 11221 Roe Avenue EMAIL cy'com a smorb @bukat en ADDRESS: y y g INSURER(S)AFFORDING COVERAGE I NAIC# Leawood KS 66211 INSURER A:Hawkeye-Security Insurance 36919 INSURED INSURER B American Fire and Casualty Company 1 24066 R E Pedrotti Co. , Inc INSURERC:Capitol Specialty Insurance Corp I 5855 Beverly, Suite A INSURERD: INSURER E: Mission KS 66202 INSURERF: COVERAGES CERTIFICATE NUMBER:2016 MASTER 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 I TYPE OF INSURANCE INSD ISWVD I POLICY NUMBER I(MM DDY/YYYY)I(MM DD//YYYY)I LIMITS X I COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE Is 1,000,000 RENTE A I CLAIMS-MADE OCCUR PREM SESO(Ea occurrence) I$ 100,000 I CBP8689341 6/1/2016 6/1/2017 MED EXP(Any one person) I$ 5,000 I PERSONAL 8 ADV INJURY I$ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE I$ 2,000,000 POLICY X jE LOC I PRODUCTS-COMP/OP AGG I $ 2,000,000 I I OTHER: I Employee Benefits I$ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT I$ I(Ea accident) ANY AUTO I BODILY INJURY(Per person) I$ ALL OWNED SCHEDULED I BODILY INJURY(Per accident)Is AUTOS AUTOS ON-O I$ NON-OWNED I PROPERTY DAMAGE ED (Per accident) I I HIRED AUTOS i�AUTOS � is X UMBRELLA LIAB X OCCUR IEACH OCCURRENCE Is 5,000,000 A I EXCESS LIAR CLAIMS-MADE AGGREGATE I$ 5,000,000 I DED I X I RETENTION$ 10,000 CU8683442 6/1/2016 6/1/2017 I$ WORKERS COMPENSATION I X I STATUTE I I OERH I AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N I E.L.EACH ACCIDENT I$ 1,000,000 OFFICER/MEMBER EXCLUDED? N N/A B (Mandatory in NH) XWA55155801 6/1/2016 6/1/2017 I E.L.DISEASE-EA EMPLOYEE$ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT I$ 1,000,000 C PROFESSIONAL SGC03854-03 10/3/2015 10/3/2016 Each Erroneous Act $2,000,000 $10,000 Ded/Each Act Aggregate $2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) PROJECT: SALINA WATER TREATMENT AND WASTEWATER TREATMENT PLANTS SCADA SYSTEMS PROJECT #09-2780 CITY OF SALINA IS ADDITIONAL INSURED, EXCLUDING WORKERS COMPENSATION, AS REQUIRED BY WRITTEN CONTRACT. 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 PROVISIONS. ATTN: MARTHA TASKER P 0 BOX 736 AUTHORIZED REPRESENTATIVE SALINA, KS 67402 , Qom_ 'f-Y 1. Sandra Morby/SMORBY ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)