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Insurance Certificate
----1 ACORCY CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) `..-.----- 1 u1/2019 11/I/2013 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 Lockton Companies CONTACT 444 W.47th Street,Suite 900 PHONE FAX Kansas City MO 64112-1906 E-M No.Ext): (ac.No/: AIL (816)960-9000 A ADDRESS: INSURERIS)AFFORDING COVERAGE NAIC it INSURER A: The Charter Oak Fire Insurance Company 25615 INSURED MCCOWNGORDON COMPANIES,INC. INSURER B: Travelers Property Casualty Co of America 25674 1305781 MCCOWNGORDON CONSTRUCTION,LLC PB GROUP,LLC,850 MAIN,LLC INSURER C: The Standard Fire Insurance Company 19070 - 422 ADMIRAL BLVD.,SUITE 100 INSURER D: The Travelers Indemnity Company 25658 KANSAS CITY MO 64106 INSURER E: INSURER F: COVERAGES * CERTIFICATE NUMBER: 12780577 REVISION NUMBER: XXXXXXX 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 ADOL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE 0450 IWO POLICY NUMBER IMM/DD nYYYI IMMIDDIYYYYI, LIMITS A x COMMERCIAL GENERAL LIABILITY y y DTC0893J700ACOFI8 II/1/2018 11/1/2019 EACH OCCURRENCE S 1.000.000 CLAIMS-MADE n OCCUR PREMISESIEaEoNTED currnce& $ 300.000 MED EXP(Any one person) $ 5.000 PERSONAL S ADV INJURY 5 1.000.000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2.000.000 HPOLICYn JET OTHER: LOC PRODUCTS-COMP/OP AGG $ 2.000.000 OTHER:El A AUTOMOBILE LIABILITY y y DT8100L3314991826G 11/1/2018 11/1/2019 IEOMaHI�NEDISINGLE LIMIT s 1.000.000 — X ANY AUTO BODILY INJURY(Per person) $ XXXXXXX AUTOS ONLY SCHEDULED BODILY INJURY(Per acddenl $ XXXXXXX X AUTOS ONLY X AUTOS ONLY 'Petr anDAMAGE $ XXXXXXX $ XXXXXXX D X UMBRELLALIAB X OCCUR Y Y DTSMCUPSL7079141526 11/1/2018 11/1/2019 EACH OCCURRENCE $ 1.000.000 EXCESS LIAB CLAIMS-MADE AGGREGATE 5 1.000.000 DED X RETENTION 510.000 S XXXXXXX C AND EMPLOYERSEWORKERS LIABnJTY YIN Y DTCUBOL703343 1826G 11/1/2018 11/1/2019 X s annm ER ANY PROPRIETORRARTNERIFXECUTNE ® E.L.EACH ACCIDENT NIA $ 1.000.000 OFFICER/MEMBER EXCLUDED, Panda:my In NH) _ �a EL gSHSE.EAFB.FLOTEE $ I,000,000 DESLRI�O OF OPERATIONS bet-. E .DISEASE-POLICY LIMIT S 1.000.000 A EQUIPMENT FLOATER N NQT6603720B454C0FI8 11/1/2018 11/1/2019 LEASED&RENTEDSI.500,000 PER B BLANKET BUILDERS QT6600H524865TIL 18 11/1/2018 11/1/2019 ITEMJALS.SI.000DED RISK •••SEE ATTACHMENT*** DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: BICENTENNIAL CENTER RENOVATION PROJECT 413-3014. THE CITY OF SALINA KANSAS AND FREW DEVELOPMENT GROUP ARE ADDITIONAL INSURED AS REQUIRED BY WRITTEN CONTRACT ON A PRIMARY AND NON-CONTRIBUTORY BASIS. WIAVER OF SUBROGATION APPLIES AS ALLOWED BY LAW. 30 DAYS NOTICE OF CANCELLATION PROVIDED TO CERTIFICATE HOLDER. CERTIFICATE HOLDER CANCELLATION See Attachment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 12780577 AUTHORIZED REPRESENTATIVE THE CITY OF SALINA KANSAS 300 W.ASH STREET SALINA KS 67401 // ACORD 25(2016/03) ©1968-2015 ACORD CORPORATION.All rights reserved The ACORD name and logo are registered marks of ACORD Miscellaneous Attachment : M47412 Master ID: 1305731. Certificate ID: 12780577 BLANKET BUILDERS RISK: $150,000,000 MASONRY NON-COMBUSTIBLE & FIRE RESISTIVE $150,000,000 NON-COMBUSTIBLE $15,000,000 JOISTED MASONRY $ 3,000,000 FRAME $ 2,500,000 SOFT COSTS $1,000,000 TEMPORARY STORAGE/TRANSIT $ 10,000,000 EARTHQUAKE - HIGH HAZARD $ 25,000,000 EARTHQUAKE - MODERATE HAZARD $ 150,000,000 EARTHQUAKE - OUTSIDE HIGH HAZARD $ 10,000,000 FLOOD - ZONE A $ 10,000,000 FLOOD - ZONE D $ 10,000,000 FLOOD - NON-PARTICIPATING $ 25,000,000 FLOOD - ZONE B, X (SHADED) AND X-500 $ 150,000,000 FLOOD - ZONE C AND X (UNSHADED) DEDUCTIBLES: $10,000 ALL OTHER CAUSES OF LOSS $25,000 INTERIOR BUILDER OUT OR TENANT UP-FITS EARTHQUAKE DEDUCTIBLES: 5% OF LOSS SUBJECT TO $ 250,000 MIN - HIGH HAZARD $ 50,000 MODERATE HAZARD $ 500,000 OUTSIDE HIGH HAZARD FLOOD DEDUCTIBLES: 5% OF LOSS SUBJECT TO $ 250,000 MIN - ZONE A, V & D $ 100,000 - ZONE D, NON-PARTICIPATING, ZONE B, X500 $ 25,000 - ZONE C AND X (SHADED) ----1 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMWDD(YYYY) 1/4.------ 3/30/2019 3/27/2018 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 Lockton Companies CONTACT NAME: 444 W.47th Street,Suite 900 PHONE FAX (NCKansas City MO 64112-1906E-MAIL"°,Eat): A c.NOED (816)960-9000 ADDRESS: INSURERISI AFFORDING COVERAGE NAIC# INSURER A: 19'199 Harbor Insurance Company IXL Group) 36940 INSURED MCCOWNGORDON COMPANIES,INC. INSURER B: 1063193 MCCOWNGORDON CONSTRUCTION,LLC PB GROUP,LLC,850 MAIN,LLC INSURER C: 422 ADMIRAL BLVD.,SUITE 100 INSURER D: — KANSAS CITY MO 64106 INSURERE: INSURER F: COVERAGES * CERTIFICATE NUMBER: 13197197 REVISION NUMBER: XXXXXXX 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 SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER jMWDDWYYY)IMMJDD(/YYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ XXXXXXX CLAIMS-MADEn OCCUR NOT APPLICABLE DAMAGE AA AIEET RErEa RENTED S XXXXXXX _ _ l ' MED EXP(My one Person) S XXXXXXX PERSONAL 8 ADV INJURY S XXXXXXX GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ XXXXXXX POLICYf JEa FluxFluxOTHER: PRODUCTS-COMP/OPAGG S XXXXXXX OTHER: S AUTOMOBILE LIABILITY COMBINEDI SINGLE LIMIT rEa INES XXXXXXX '— ANY AUTO NOT APPLICABLE BODILY INJURY(Per person) S XXXXXXX AUTOS ONLY NED ^_—SAUTOSCHEDULED BODILY INJURY(Per accident 5 XXXXXXX • HIRED NON-OWNED PROPERTY DAMAGE S XXXXXXX _ AUTOS ONLY _AUTOS ONLY (Per acdden0 5 UMBRELLA LIAB _OCCUR EACH OCCURRENCE 5 XXXXXXX EXCESS LIAR CLAIMS-MADE NOT APPLICABLE AGGREGATE S XXXXXXX DED RETENTION S S WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y(N NOT APPLICABLE PER ER ANY PROPRIETOWPARTNEWEXECUTNE $ XXXXXXX OFFICER/MEMBER EXCLUDEDi ri N(A E L EACH ACCIDENT V XV ( r4atwN) EX yInN L.WSFACF-EA EMPLOYEE $ XXXXXXX _ — —-- DESCRIP�TI N OF OPEPATIONSoebwX E.L.g5E45E-POLICY OMIT 5 XXXXXXX A POLLUTION& V XI CE044688702 4/30/2018 4/30/2019 55.000.000 EACH OCC:55.000,000 PROFESSIONAL GEN.AGO:5100K DED FOR PROF: LIABILITY 525K DED.FOR POLL. DESCRIPTION OF OPERATIONS(LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:BICENTENNIAL CENTER RENOVATION PROJECT 413-3014. THE CITY OF SALINA KANSAS NAD FREW DEVELOPMENT GROUP ARE ADDITIONAL INSURED AS REQUIRED BY WRITTEN CONTRACT. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 13197197 AUTHORIZED REPRESENTATIVE THE CITY OF SALINA KANSAS 300 W.ASH STREET SALINA KS 67401 ACORD 25(2016103) ©1988-2015 ACORD CORPORATION.All rights reserved The ACORD name and logo are registered marks of ACORD ACORE" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) ke....../. 4/30/2016 5/1/2015 I 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 Lockton Companies CONTACT 444 W.47th Street,Suite 900 PHHOONE FAX Ext): I FX,No): Kansas City MO 64112-1906 .- E-MAIL (816)960-9000 ADDRESS: INSURERS)AFFORDING COVERAGE NAIC# INSURER A: Indian Harbor Insurance Company(XL Group) 36940 • INSURED MCCOWNGORDON COMPANIES,INC. INSURER B: 1063193 MCCOWNGORDON CONSTRUCTION,LLC PB GROUP,LLC INSURER C 422 ADMIRAL BLVD.,SUITE 100 . INSURER D: KANSAS CITY MO S4106 INSURER E: _INSURER F: - COVERAGES * CERTIFICATE NUMBER: 12909040 REVISION NUMBER: XXXXXXX _THIS IS TO_CERTIFY THAT THE POL!C!ES 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 SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD VVVD POLICY NUMBER (MM/DD/YYYY)(MM/DD/YYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ )00000(X CLAIMS-MADE n OCCUR NOT APPLICABLE DAMAGE TO RENTED I I PREMISES(Ea occurrence) $ XXX)QxXX MED EXP(Any one person) $ )00000a - - PERSONAL&ADV INJURY $ )QOCXXXX GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ XXXXXXX PRO- OTHER ]JECT n LOC PRODUCTS-COMP/OP AGG $ XXXXXXX OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT NOT APPLICABLE (Ea accident) $ XXXXX) ' ANY AUTO BODILY INJURY(Per person) $ XXXXX) ALL OWNED SCHEDULED BODILY INJURY(Per accident $ AUTOS AUTOS ( )00(XX X HIRED AUTOS NON-OWNED PROPERTY DAMAGE U $ XXXX)1XX (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ )00000(X EXCESS LIAB CLAIMS-MADE NOT APPLICABLE AGGREGATE $ XXXXXXXJ DED I I RETENTION$ $ WORKERS COMPENSATION PER 10TH- AND EMPLOYERS'LIABILITY Y I N NOT APPLICABLE I STATUTE I I FR ANY PROPRIETOR/PARTNER/EXECUTIVE [ ] N/A E.L.EACH ACCIDENT $ XXXXXXX OFFICER/MEMBER EXCLUDED? I I `` vvVVVvVV (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ X��/'�)�.XXXX It yes,describe under vv vvvtry DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT -$ X..)00 XIIXX A POLLUTION& N N CPL741018902 4/30/2015 4/30/2016 52,000000-EACH-OCC;53;000.000 -- PROFESSIONAL GEN.AGG;5100K DED FOR PROF; _ LIABILITY - I525K DED.FOR POLL. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,may be attached if more space is required) PROJECT:SALINA BICENTENNIAL CENTER RENOVATIONS. • . . CERTIFICATE HOLDER CANCELLATION - .. -. . . SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 12909040 AUTHORIZED REPRESENTATIVE CITY OF SALINA CITY CLERKS OFFICE 300 W.ASH STREET - PO BOX 736 SALINA KS 67402-0736 '��'/h mot'/� /Y! t ACORD 25(2014/01) ©1 88-2014 ACORD CORPORATION.All rights reserved The ACORD name and logo are registered marks of ACORD -----1 ACORLY CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) �..----- 4/30/2016 5/1/2015 _ --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 Lockton Companies CONTACT 444 W.47th Street,Suite 900 PHONE FAX .- Kansas City MO 64112-1906 (E MA Lo,E rt): (A/c,No): (816)960-9000 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Indian Harbor Insurance Company(XI.Group) 36940 INSURED MCCOWNGORDON COMPANIES,INC. INSURER B: 1063193 MCCOWNGORDON CONSTRUCTION,LLC PB GROUP,LLC INSURER C 422 ADMIRAL BLVD.,SUITE 100 INSURER D: 1 KANSAS CITY MO 64106 INSURER E: INSURER F: COVERAGES * CERTIFICATE NUMBER: 13197197 REVISION NUMBER: XXCXXXX 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 SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY)IMMIDD/YYYY), LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ X3X�Oi CLAIMS-MADE I I OCCUR NOT APPLICABLE PREMISESO(ERENTED nce) $ XXXXXXX I I MED EXP(Any one person) $ XXXXXXX PERSONAL&ADV INJURY $ XOCXXXJOC GEM_AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ =0 0M PRO- POLICY JECT LOC PRODUCTS-COMP/OP AGG $ )000000( OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT NOT APPLICABLE (Ea accident) $ XXXXX� ANY AUTO BODILY INJURY(Per person) $ XXXXXXX ALL OWNED SCHEDULED BODILY INJURY(Per accident $ AUTOS _AUTOS ( XX�OXX NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) $ =OIXM $ UMBRELLA LIAB _OCCUR EACH OCCURRENCE _$ XVOCXXX EXCESS LIAB CLAIMS-MADE NOT APPLICABLE AGGREGATE $ )OOCXXXX DED I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N NOT APPLICABLE I STATUTE I I FR ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ )000000( OFFICER/MEMBER EXCLUDED? V ,`XX (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ XXXXX ' If yes,describe under V Vv� DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ /�-�.�./OOOX. A POLLUTION& Y N CPL741018902 4/30/2015 4/30/2016 $2,000,000 EACH OCC:.$3.000,000 - — — PROFESSIONAL GEN.-AGG:5100K DED FOR PROF; —_LIARQ ITY I 525K DED.FOR POLL. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: BICENTENNIAL CENTER RENOVATION PROJECT#13-3014. THE CITY OF SALINA KANSAS CNAD FREW DEVELOPMENT GROUP ARE ADDITIONAL INSURED AS REQUIRED BY WRITTEN CONTRACT. CERTIFICATE HOLDER CANCELLATION . SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 13197197 AUTHORIZED REPRESENTATIVE THE CITY OF SALINA KANSAS 300 W.ASH STREET SALINA KS 67401 ACORD 25(2014/01) ©1988-2014 ACORD CORPORATION.All rights reserved The ACORD name and logo are registered marks of ACORD ACORCr CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YY,YY) ke.....-/- 4/30/2016 5/1/2015 it 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 Lockton Companies CONTACT 444 W.47th Street,Suite 900 PHONE 1 FAX Kansas City MO 64112-1906 (A/C, -MAIL ,E<t): (A/C,No): (816)960-9000 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Indian Harbor Insurance Company(XL Group) 36940 INSURED MCCOWNGORDON COMPANIES,INC. INSURER B: 1063193 MCCOWNGORDON CONSTRUCTION,LLC PB GROUP,LLC INSURER C 422 ADMIRAL BLVD.,SUITE 100 INSURER D: KANSAS CITY MO 64106 INSURER E: INSURER F: COVERAGES * CERTIFICATE NUMBER: 12782071 REVISION-NUMBER: XXXXXXX -- - 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 SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY)(MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ XXXXXXX CLAIMS-MADE OCCUR NOT APPLICABLE DAMAGE TO RENTED PREMISES(Ea o'rtlrrence) $ XXXXXXX MED EXP(Any one person) $ XXX00 IX — PERSONAL&ADV INJURY $ XXXXXXX GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ =00(XX PRO- OTHER n JECT n LOC PRODUCTS-COMP/OP AGG $ XXXXXXX OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT NOT APPLICABLE (Ea accident) $ XXXXXXX ANY AUTO BODILY INJURY(Per person) $ XXXXXXX ALL OWNED SCHEDULED BODILY INJURY(Per accident $ AUTOS —AUTOS ( _ X� XX HIRED AUTOS AUUTOSWNED (Per PROPERTY d DAMAGE $ )00000a $ UMBRELLA LIAB _OCCUR EACH OCCURRENCE $ X000000( EXCESS LIAB CLAIMS-MADE NOT APPLICABLE AGGREGATE $ )00000X' DED I I RETENTION$ $ WORKERS COMPENSATION I PER 1 ICITH- AND EMPLOYERS'LIABILITY Y/N NOT APPLICABLE STATUTE FR ANY PROPRIETOR/PARTNER/EXECUTIVE I�I N/A E.L.EACH ACCIDENT $ XXXXXXX OFFICER/MEMBER EXCLUDED? I I `,J7-V�rV�rVVVvVv vV (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ XXXXXIX If yes,describe under V V V tT�T� DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S XXVOCXX A POLLUTION& N N CPL741018902 4/30/2015 4/30/2016 $2,000,000 EACH OCC;$3,000,000 -- -- •— PROFESSIONAL --—• GEN.AGG;$100K DED FOR PROF; __-—-LIABILITY 525K DED.FOR POLL. DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:BICENTENNIAL CENTER RENOVATION PROJECT#13-3014. CERTIFICATE HOLDER CANCELLATION - - --.. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 12782071 AUTHORIZED REPRESENTATIVE THE CITY OF SALINA KANSAS 300 W.ASH STREET SALINA KS 67401 "</-7 -Z4' ACORD 25(2014/01) ©1 88-2014 ACORD CORPORATION.All rights reserved The ACORD name and logo are registered marks of ACORD -----1 ACORL° CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) L■----- 11/1/2015 10/28/2014 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 Lockton Companies NAM : 444 W.47th Street,Suite 900 PHONE 1 FAX Kansas City MO 64112-1906 No,Ext): (ac,No). E-MAIL E-M (816)960-9000 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: The Charter Oak Fire Insurance Company 25615 INSURED MCCOWNGORDON COMPANIES,INC. INSURER B: The Travelers Indemnity Company 25658 1068745 MCCOWNGORDON CONSTRUCTION,LLC INSURER c: Farmington Casualty Company 41483 PB GROUP,LLC 422 ADMIRAL BLVD.,SUITE.100 INSURER D: KANSAS CITY MO 64106 INSURER E: • INSURER F: COVERAGES * CERTIFICATE NUMBER: 12794946 REVISION NUMBER: XXXXXXX 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 SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER IMMIDDIYYYY)IMM/DD/YYYYI LIMITS A X COMMERCIALGENERALLIABILITY y y DTC0893J700ACOF14 11/1/2014 11/1/2015 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE© OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ 300,000 _ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000.000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY© PE n LOC I PRODUCTS-COMP/OP AGG $ 2,000.000 OTHER $ A AUTOMOBILE LIABILITY Y Y DT810893J700ACOF14 11/1/2014 11/1/2015 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ )(XXXXXX _ AUT OWNED SCHEDULED BODILY INJURY(Per accident $ XXXXXXX X HIRED AUTOS X AUUTOSWNED PROPERTY DAMAGE $ XXXXXXX (Per accident) $ XXXXXXX B X UMBRELLA LIAB X OCCUR Y Y DTSMCUP893J700AIND14 11/1/2014 11/1/2015 EACH OCCURRENCE _$ 1,000,000 _ EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED I X I RETENTION$10,000 $ XXXXXXX WORKERS C AND EMPLOYERS'LIABILITY Y/N Y DTFUB893J700AI4 11/1/2014 11/1/2015 X I STATUTE I I OFR ANY PROPRIETOR/PARTNER/EXECUTIVE © N/A E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 __If D.ESC DESCRIPTION N.OF - - — - -- E.L.DISEASE-POLICY LIMIT 5 1,000,000 ,describe under__ DES OPERATIONS below A EQUIPMENT FLOATER N N QT6603720B454C0F14 11/1/2014 11/1/2015 LEASED&RENTED 51,500,000; SI,000 DED DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,may be attached if more space is required) PROJECT: SALINA BICENTENNIAL CENTER RENOVATIONS. CITY OF SALINA, KS,CONVERGENCE DESIGN. LLC, DION LOUTHAN, DIRECTOR OF PARKS AND RECREATION ARE ADDITIONAL INSURED AS REQUIRED BY WRITTEN CONTRACT AS THEIR INTEREST MAY APPEAR INCLUDING COMPLETED OPERATIONS. WAIVER OF SUBROGATION APPLIES AS ALLOWED BY LAW. INSURANCE IS PRIMARY AND NON-CONTRIBUTORY. 30 DAYS NOTICE OF CANCELLATION PROVIDED FOR CERTIFICATE HOLDER. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 12794946 AUTHORIZED REPRESENTATIVE CITY OF SALINA CITY CLERKS OFFICE 300 W.ASH STREET PO BOX 736 SALINA KS 67402-0736 xl'1 ACORD 25(2014/01) ©1 88-2014 ACORD CORPORATION.All rights reserved The ACORD name and logo are registered marks of ACORD