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Survey Support Vapor Intrusion Former Schilling Air Force Base 1 �� R� DATE(MM/DD/YYYY) ® '`� CERTIFICATE OF LIABILITY INSURANCE 5/21/2016 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 Julie Ellis I Coryell Insurors, Inc. PHONE (785)238-5117 FAX 120 West 7th Street _(A/c No,Ext): (A/C,No): (785)238-1647 E-MDRAIESS:3 � 3 L ulie @co ell'c.cora AD PO Box 580 INSURER(S)AFFORDING COVERAGE NAIC# Junction City KS 66441 INSURERA:The Hartford - Commercial 29424 INSURED INSURER B:Philadelphia Insurance Co. 18058 Kaw Valley Engineering Inc. INSURER C: P. O. Box 1304 INSURERD: INSURER E: Junction City KS 66441 INSURERF: _ _COVERAGES ____ __ —CERTIFICATE NUMBER:CL1652102172_ - __ _ -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. NOTVVITHSTANDING 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. ILTR I TYPE OF INSURANCE I$DWVD I POLICY NUMBER I(MM/DD/YYYY)I(MM/DD/YYYY) LIMITS I X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 - A CLAIMS-MADE X OCCUR DAMAGE TO RENTED 300,000 PREMISES(Ea occurrence) S X 37UUN AQ2513 6/1/2016 6/1/2017 MED EXP(Any one person) $ 10,000 I I PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 I X I POLICY PRO I JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 I[1 OTHER: $ I AUTOMOBILE LIABILITY CO aBINEDtSINGLE LIMIT $ 1,000,000 B X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED PHPK1499591 6/1/2016 6/1/2017 BODILY INJURY Per accident $ AUTOS AUTOS X ( ) X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS _(Per accident) $ I I Uninsured motorist BI-single $ 1,000,000 X UMBRELLA LIAB OCCUR I EACH OCCURRENCE $ 4,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 4,000,000 I I DED I X I RETENTION$ 0 37 XHU AQ9984 6/1/2016 6/1/2017 $ WORKERS COMPENSATION PE 0T R H- AND EMPLOYERS'LIABILITY Y/N I STATUTE I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A A (Mandatory in NH) 37 WE CD4746 6/1/2016 6/1/2017 E.L.DISEASE-EA EMPLOYEE$ 1,000,000 If yes,describe under _ _ _ _ _ _ _ DESCRIPTION OF"OPFjRATIONSbelow --._ I I 1 JI E.L.DISEASE-POLICY LIMIT I$ 1 - 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Vapor Intrustion Investigation Agreement KVE Project: E14S0936 It is agreed The Public Entities, City of Salina, KS and The Dragun Corporation (Consultant) are named as Additional Insured with respect to General Liability and Automobile Liability or any other aslrequired by contract. Waiver of Subrogation as enforceable by Kansas State Law. 30 day cancellation clause applies. CERTIFICATE HOLDER _CANCELLATION I nancy.schuessler @salina.or I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Salina, KS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 736 ACCORDANCE WITH THE POLICY PROVISIONS. Salina, KS 67402-0736 AUTHORIZED REPRESENTATIVE I\ f ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD • INS025(201401)