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Cert of Insurance A`°R°® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/11/2014 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 Brenda Smith Assurance Partners PHONE FAX limn Ext1 (800)563-1871 IA/C.NoI: (785)825-5098 201 E Iron St. ApDRIE _bsmith @yourassurance.com P.O. BOX 1213 INSURER(S)AFFORDING COVERAGE NAIC# Salina KS 67402-1213 INSURERA:Add1SOn Insurance Company 10324 INSURED INSURERS:Midwest Builders' Casualty 13126 Glassman Corporation INSURER C: PO Box 218 INSURER D: INSURER E: Hays KS 67601 INSURERF: COVERAGES CERTIFICATE NUMBER:2015 we renewal 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 LTR INSR WVD POLICY NUMBER IMM/DD/YYYY) (MM/DD/YYYY) LIMITS GENERAL UABIUTY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(Ea occurrence) $ 300,000 A CLAIMS-MADE X OCCUR 60381453 4/1/2014 4/1/2015 MED EXP(Any one person) $ 5,000 PERSONAL S ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X PF Ti LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 A X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 60381953 4/1/2014 4/1/2015 BODILY INJURY(Per $ AUTOS AUTOS ( ) X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE _ AUTOS (Per accident) $ Medical payments $ UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 5,000,000 A X EXCESS UAB , CLAIMS-MADE AGGREGATE —H $ 5,000,000 , DED X RETENTIONS 10,000 60381453 4/1/2014 4/1/2015 $ -B WORKERS WC STATU- OTH- AND EMPLOYERS'LIABIUTY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE .... EACH ACCIDENT $ 500 OFFICER/MEMBER EXCLUDED? N N/A ,000 (Mandatory in NH) 15BWC0895 1/1/2015 1/1/2016 E.L.DISEASE-EAEMPLOYEE $_-_______500-,.000 — Ifyes,-desc be under - - --— DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 A Leased/Rented Equip 60381453 4/1/2014 4/1/2015 $150,000 Installation Fltr $800,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Removal & Replacement of chiller at Salina Police Department administration building. 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. City Clerk 300 W Ash AUTHORIZED REPRESENTATIVE Salina, KS 67401 Brenda Smith/DWALKE ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD A`°R°® CERTIFICATE OF LIABILITY INSURANCE 9AZi�olD;"'") 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 PHONE (800)563-1871 I rAA/X4 N91.(78S)825-5098 Mt No Ertl' 2090 S. Ohio ADID'DRRESS:rblairCkyourassurance.com P.O. Box 1213 INSURERS)AFFORDING COVERAGE NAIL• Salina KS 67402-1213 INSURERAMid-Continent Casualty 0033 INSURED INSURER B Depo s l tors 42587 Ferco, Inc. INSuRERcNational Union Fire of Pittsbu Frank Construction Co. , Inc. INSURERD:KBIWCF 0010 PO Box 47 IN SURERE:Hartford Fire Insurance Co 19682 Salina KS 67402-0047 INSURER F: COVERAGES CERTIFICATE NUMBERPec2013A11 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. w l TYPE OF INSURANCE LINER ISy VQI POLICY NUMBER I DYYWDCDWI(MMDVYI (MYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMAGE TO NTED X COMMERCIAL GENERAL LIABILITY PREMISES(Eoccurrence) $ 100,000 A I CLAIMS-MADE © OCCUR X Y 04GL894647 12/15/201312/15/2014 MEDEXP(An),one person) S Excluded PERSONALS ADM INJURY 5 1,000,000 GENERAL AGGREGATE 5 2,000,000 GENL AGGREGATE OMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 I POLICY I X I PR6 1 I—I LOC I S AUTOMOBILE WBILITY I COMBINED SINGLE LIMIT (Ea accident! S 1,000,000 X ANY AUTO BODILY INJURY(Per person) S B ALL OV.NED SCHEDULED x y ACP7215971010 12/15/201312/15/2014 BODILYINNRY(Pe'acddem) $ X HRTED AUTOS X AUT-0WNED (Per amdenlDAMAGE 5 S UMBRELLA LIAB X OCCUR EACH OCCURRENCE 5 2,000,000 — c x EXCESS UAB CLAIMS-MADE AGGREGATE 5 2,000,000 OED I X I RETENTIONS 0 8E066654306 12/15/2013 12/15/2014 5 D WORKERS COMPENSATION y x I T RY LI TU. I IGFR AND EMPLOYERS LIABILITY ANY PROPRIETORJPARTNERIEXECUTIVE Y1�N1 NIA E.L.EACH ACCIDENT 5 1,000,000 (Mandatory In NH)EXCLUDED'? I I 20141559 1/1/2014 1/1/2015 E.L.DISEASE•EA EMPLOYEE 5 1,000,000 OFFICER/MEMBER N NH) DYes. IPTION OF O DESCRIPTION OF OPERATIONS tam E DISEASE-POLICY LIMIT 5 1,000,000 E Rigger's Liability 37HSEW7391 12/15/201312/15/2014 Any OneRipytry $250,000 DESCRIPTION OF OPERATIONSI LOCATIONSI VEHICLES (Attach ACORD 101,Additional Remarks Schedule,U more space Is required) Salina Police Department Chiller Replacement. Glassman Corporation is named as an additional insured to general liability and auto liability. General liability includes primary, non-contributory and completed operations. Waiver of subrogation is also included for general liability, auto liability and workers' compensation as allowed by state statue. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Corporation On ACCORDANCE WITH THE POLICY PROVISIONS. Glassman P.O. Box 218 900 Commerce Parkway AUTHORIZED REPRESENTATNE Hays, KS 67601 Susan Flaming/SFLAMI -2-- -J_P-�_ : .a ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025r,mtnctm The ACnon name and Innn are ranietered medic of 8CfGn Ck— r1J 5 1l 15111