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Insurance Certificate A`O O® CERTIFICATE OF LIABILITY INSURANCE DATE(MMmo1 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 COOMNTACT Susan Flaming Assurance Partners PHONE (800)563-1871 FAX (785)825-5098 (NC,No.Eat): (A/C.No): 201 E Iron Avenue E-MAIL sfamin ADDRESS: 9@YOUra55Urance.COm P.O.Box 1213 INSURER(S)AFFORDING COVERAGE NAI Salina KS 67402-1213 INSURERA: AMCO Insurance Company 19100 INSURED INSURER e: Midwest Builders'Casualty Mutual Company 13126 Stevens Contractors,Inc. INSURER C: PO Box 1276 INSURER D: INSURER E: Salina KS 67402-1276 INSURERF: COVERAGES CERTIFICATE NUMBER: 19.20WC/18.19Pkg 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 ADM_I USR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD NAD POLICY NUMBER (MMIDDIYYYY) (MM/DDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE 5 CLPIMSJMDE X OCCUR DAMAGESt RENTED 100,000 PREMISES Ea occurrence) 5 MED EXP(Any one arson) 5 5.000 A Y Y ACP3046780478 09/01/2018 09/01/2019 PERSONAL 8.ADV INJURY S 1.000.000 GEN_AGGREGATE OMR APPLIES PER: GENERALAGGREGATE 5 2.000.000 PRP POLICY n JECT LOC PRODUCTS-COMP/OP AGG s 2.000.000 OTHER: Pollution Liability s 1.000,000 AUTOMOBILEUARILITY COMBINED SINGLELIMIT $ 1000000 IEa accident) _ X ANY AUTO BODILY INJURY(Pet person) S A OWNED SCHEDULED Y Y ACP3046780478 09/01/2018 09/01/2019 BODILY INJURY(Per awdeml $ AUTOS ONLY AUTOS X HIRED =TONNES-OWNED AM PROPERTY DAMAGE AUTOS ONLY _ AUTOS ONLY /Per amdent) 5 X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 2.000.000 _ A EXCESS UAB CLAIMS-MADE 09/012018 09/01/2019 AGGREGATE $ 2.000.000 DED X RETENTION$ 0 $ WORKERS COMPENSATION [SMOTE Y/N X STATUTE X ER B ANY PROPRIETOR/PARTNER/EXECUTNE ❑ NIA Y WC100-0001106-2019A 01/01/2019 01/012020 EL.EACH ACCIDENT OFFICE $ 1.000.000(Mandatooryry in n ER EXCLUDED?NH) EL DISEASE-EA EMPLOYEE 5 1.000.000 IT yes,desaunder 1 000 000 DESCRIPTIONON OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CG7323,CG7246,AC7005,WC00313 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. PO Box 736 AUTHORIZED REPRESENTATIVE Salina KS 67402-0736 .J- s. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) • The ACORD name and logo are registered marks of ACORD A O CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDI 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 NONE CT Susan Flaming Assurance Partners PHONE (800)563-1871 FAX (785)825-5098 (A ,No.Eat): (NC,No): IC 201 E Iron Avenue E-MAIL - IIL55: sfaminggyourassurance.com P.O.Box 1213 INSURER(5)AFFORDING COVERAGE NAIL a Salina KS 67402-1213INSURERA: AMCO Insurance Company 19100 INSURED INSURER B: Midwest Builders'Casualty Mutual Company 13126 Stevens Contractors,Inc. INSURER C: PO Box 1276 INSURER D: INSURER E: Salina KS 67402-1276 INSURER F: COVERAGES CERTIFICATE NUMBER: 19.20WC/18.19Pkg 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 ADDL UBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE /NSD VND POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE nOCCUR DAMAGE TO RcN TED 100,000 PREMISES(Ea occurrence) 5 MED EXP(Any ason) S 5,000pa per A Y Y ACP3046780478 09/01/2018 09/01/2019 PERSONAL SADV INJURY S 1.0•04:1° GEM_AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2.000.000 I POLICY OX JET n LOC PRODUCTS-COMP/OP AGG S 2.000,000 I OTHER: Pollution Liability s 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE UMIT 5 1,000,000 lEa acddanti X ANY AUTO BODILY INJURY(Per person) S A OWNED I SCHEDULED Y Y ACP3046780478 09/01/2018 09/01/2019 BODILY INJURY(Per accident) $ AUTOS ONLY I AUTOS X HIRED I NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY X AUTOS ONLY (Per aC dem) $ X UMBRELLA UAB X OCCUR EACH OCCURRENCE 5 2.000.000 A EXCESS LIAs CLAIMS-MADE ACP3046780478 09/01/2018 09/01/2019 AGGREGATE S 2.000.000 DED X RETENTION S 0 S WORKERS COMPENSATION X STAPER 0T yH- AND EMPLOYERS'LIABILITY 'N TUTE X ER BANY PROPRIETORIPARTNERIEXECUTNE EL EACH ACCIDENT S 1.000.000 DFFICERNEMBER EXCLUDED? n NIA Y WC100-0001106-2019A 01/01/2019 01/01/2020 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 133°000 II yes,describe under 1,C":0°0 D�D� DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 5 • DESCRIPTION OF OPERATIONS/LOCATORS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached II more space Is required) Downtown Sanitary Sewer Relocations CG7323,CG7246,AC7005,WC00313 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. Attn:Martha A.Tasker PO Box 736 AUTHORIZED REPRESENTATIVE Salina KS 67402-0736 --VILLAS" —416bstua44' ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD TE A�D CERTIFICATE OF LIABILITY INSURANCE DA08/i6/201�8 n 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 policylies)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 9 Assurance Partners PHONEFAx (AA;,No,Ertl: (800)563-1871 ( No): (785)825-5098 201 E Iron Avenue E-MAIL sflamin ADDRESS: 9@Yourassurance.com PO.Box 1213 INSURER(5)AFFORDING COVERAGE NAICI Salina KS 67402-1213 INSURER A: AMCO Insurance Company 19100 INSURED INSURER B: Midwest Builders'Casualty Mutual Company 13126 Stevens Contractors,Inc. INSURER C: PO Box 1276 • INSURER D: INSURER E: Salina KS 67402-1276 INSURER F: COVERAGES CERTIFICATE NUMBER: 18.19 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. NOTIMTHSTANDING 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 ADOL USN POLICPLFF POLICY EXP LTR TYPE OF INSURANCE INSD.MD POLICY NUMBER (MMIDDM'YY) (MMmD/YYYY) UNITS X COMMERCIAL GENERAL LIABILITY 1,000,000 EACHGCCURRENCE S DAMAGE TO REN I ED 100,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) S — MED EXP(Any one person) S 5,000 — A Y Y ACP3046780478 09/01/2018 09/01/2019 PERSONAL IS ADV INJURY $ 1.000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2.000,000 POLICY X PRP ri LOC PRODUCTS-COMP/OP AGG S 2.000,000 OTHER: Pollution Liability s 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE UNIT s 1.000.000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) S A OWNED SCHEDULED Y Y ACP3046780478 09/01/2018 09/01/2019 BODILY INJURY accident) 5 AUTOS ONLY _ AUTOS HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY _ AUTOS ONLY (Per accident) S X UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 2.000,000 A EXCESS UAB CLAIMS-MADE ACP3046780478 09/01/2018 09/01/2019 AGGREGATE s 2,000,000 DED X RETENTION 5 O S WORKERS COMPENSATION I vl PER DTH- AND EMPLOYERS LIABILITY �I STATUTE ER VIN 1000000 B ANY CEFLMEETORI EXCLUDED? PROPRIETOR/PARTNER/EXECUTIVE NIA Y VVC100-0001106-2018A 01/01/2018 01/01/2019 E.L.EACH ACCIDENT S OFFIdatory in HR E%CLVOED7 • (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE 5 1.000,000 It yes.describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATORS r LOCATIONS r VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If mon aPicots reputed) ? [Z - `- V'' CG7323,CG7246,AC7005,VV000313 x / L y v 1l ie; 1• g• i ti nrV Y"' •J•- as. t` :j:Jr: Ifr ty1' 1' `Y.7 0 A . c.:s N' 1l 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. PO Box 736 AUTHORIZED REPRESENTATIVE p Salina KS 67402-0736 1 y{„. ,_ �En.in_. . ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD A`°R°® CERTIFICATE OF LIABILITY INSURANCE 9A2i2oDD4"") 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 /PHCNNo Extl: (800)563-1871 ,ac.NoI•(7851825-5098 201 E Iron St. AADDRess:rblair@yourassurance.com P.O. Box 1213 INSURER(S)AFFORDING COVERAGE NAIC 9 Salina KS 67402-1213 INSURER AAMCO Insurance Company 19100 INSURED INSURER BMidwest Builders' Casualty 13126 Stevens Contractors, Inc. INSURERC: PO Box 1276 INSURER D: INSURER E: Salina KS 67402-1276 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED 10 0,0 0 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) 5 A CLAIMS-MADE X OCCUR X Y ACP3006780478 9/1/2014 9/1/2015 MEDEXP(Anyoneperson) 5 5,000 PERSONAL&ADVINJURY 5 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 7 POLICY n PRei n LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) s 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ A ALLOWNED SCHEDULED x y ACP3006780478 9/1/2014 9/1/2015 BODILY INJURY(Per accident) $ AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE S 2,000,000 DED X RETENTIONS 10,000 ACP3006780478 9/1/2014 9/1/2015 $ B WORKERS COMPENSATION y X WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE N E.L.EACH ACCIDENT S 1,000,000 OFFICER/MEMBER EXCLUDED? 14BWC1106 9/1/2014 1/1/2015 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE 5 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 5 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) City of Salina is named as an additional insured to general liability and auto liability. General liability additional insured includes completed operations. Waiver of subrogation is included for general liability, auto liability and workers' compensation to the extent permitted by law. 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. P.O. Box 736 Salina, KS 67402-0736 AUTHORIZED REPRESENTATIVE Susan Flaming/SFLAMI '— 1- -"--"j ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 nnttn t nt The annPrl name anri Innn arcs rcsnicfererl marke of erne l