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Certificate of Insurance „ ,”, OP ID: ID AC-0 °Y CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/05/2014 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 CONTACT Shawn Gallardo Keller Leopold Insurance PHONE - FAX Garden City Branch.' jNC,No,Ext):620-276-7671 (A/C,No): 620-276-0726 • 302 N.Fleming,Ste.1 E-MAIL SS:sgallardo @kellerleopold.com Garden City,KS 67846 PRODUCER ' Krista Burkhart,CISR/AFIS CUSTOMER ID#:SOUT-13 - INSURER(S)AFFORDING COVERAGE NAIC# INSURED Southwest Janitorial INSURER A:Columbia Insurance Group 40371 Service, LLC INSURER B:CNA/Western Surety Company 2606 E Fair#20 INSURER C:Accident Fund Insurance Co. 10166 Garden City, KS 67846 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.POLICY EXP ILTR I TYPE OF INSURANCE ASR WVD POLICY NUMBER I(MM/ DD/YYYY)I(MM/DD/Y YY)I LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CMPKS0000029161 11/05/2014 11/05/2015 DAMAGE TO RENTED 100,000 PREMISES(Ea occurrence) $ CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,00G GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ . 2,000,000 X I POLICY n PE� n LOC , $ -AUTOMOBILE LIABILITY _- COMBINED SINGLE LIMIT $ 1,000,000 A ANY AUTO CAPKS0000028915 06/13/2014 06/13/2015 (Ea accident) • BODILY INJURY(Per person) .$ ALL OWNED AUTOS - BODILY INJURY(Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (PER ACCIDENT) NON-OWNED AUTOS $ $ . UMBRELLA LIAB OCCUR EACH OCCURRENCE $ '— EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1 DEDUCTIBLE $ -- -:RETENTION-$- -- - - - -- -- ---- ---- - --- -- - -- - - -- --- - - - ---- WORKERS COMPENSATION I WC I y I0T TH AND EMPLOYERS'LIABILITY C ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WCV6095801 11/23/2014 11/23/2015 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? Y N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 B Janitorial Bond 71204771 12/08/2013 12/08/2014 5,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Limits shown are those in effect at date of inception. • CERTIFICATE HOLDER _ CANCELLATION CITS001 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. Attn: Ron Rouse P.O. Box 736 AUTHORIZED REPRESENTATIVE Salina, KS 67402 <9 - 1 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD