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COI ACC'ORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 10/29/2020 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 Jolene Cooper NAME:PHOE p FAX Insurance Planning Inc. (AIC NNo.Extl: (785)625-0819 (AIC,No): 1785162S-0869 3006 Broadway Avenue nooliess: coopjo®insurance-planning.com P. 0. Box 100 INSURER(S) AFFORDING COVERAGE NAIC 8 Hays KS 67601 INSURER A:Addison Insurance Company 10324 INSURED INSURER B:RLI insurance Company 13056 M & D of Hays Inc INSURER C: D & M Investments LLC INSURERD: i PO Box 184 INSURERE: Hays KS 67601-0184 INSURERF: 1 COVERAGES CERTIFICATE NUMBER:20/21 Certs 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 LTRINSR WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO A CLAIMS-MADE X OCCUR PREMISES(Ea o currrrence) 100,000 X Explosion, Collapse, UGRE 60483569 11/10/2020 11/10/2021 MED EXP(Any one person) $ 5,000 Included PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY X PRO- LOC PRODUCTS-COMP/OPAGG $ 2,000,000 $ JECT OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED 60483569 11/10/2020 11/10/2021 BODILY INJURY(Per accident) $ AUTOS _ AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS (Per accident) CA7109 Bus Auto Ultra Endl $ X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED X RETENTION $ 0 60483569 11/10/2020 11/10/2021 $ WORKERS COMPENSATION X PER ERH- AND EMPLOYERS'LIABILITY STATUTE ER YIN ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? Y A (Mandatory in NH) 60483569 11/10/2020 11/10/2021 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,aescribe under DESCRIPTION OF OPERATIONS below E .DISEASE-POLICY LIMIT $ 1,000,000 B Equip Leased/Rented from Other 1LM0704786 11/10/2020 11/10/2021 250.000 lIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Salina THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 736 Salina, KS 67402 AUTHORIZED REPRESENTATIVE Jolene Cooper/COOPJO V U I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) • ..-----", ® DATE(MMroonrr'r) ACORD CERTIFICATE OF LIABILITY INSURANCE 3/15/2019 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 Jolene Cooper . NAME: P Insurance Planning Inc. INC, o,Esn. (785)625-0819 I Iac,No): 01M625-0e69 3006 Broadway Avenue ADDRESS: coopjo@insurance-planning.com P. O. Box 100 INSURER(S)AFFORDING COVERAGE NAIL e Hays KS 67601 INSURER A:Addison Insurance Company 10324 ' INSURED INSURER B:RLI Insurance Company M & D Excavating Inc INSURER C: I Dirt Diggers LLC INSURER O: PO Box 184 INSURERE: I Hays KS 67601 INSURERF: I COVERAGES CERTIFICATE NUMBER:19/20 Certs 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. ( EXP LTR I TYPE OF INSURANCE N O I MW? POLICY NUMBER I IMMIDDADOLEIRYIYYYY) I IMMIDDEFFYIYYYYI I LIMITS X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000 DAMAGE TO RENTED A I CLAIMS-MADE OCCUR PREMISES lEa occurrence) 3 100,000 60489279 4/1/2019 4/1/2020 MED EXP(4r:y one person) 5 5,000 I PERSONAL &ADV INJURY 5 • 1,000,000 • IGEm.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 3 2,000,000 X POLICY JET LOC PRODUCTS-COMP/OPAGG 5 2,000,000 I OTHER' • - S COMBINED SINGLE LIMIT 5 1,000,000 I AUTOMOBILE LIABILITY - _.(Ea acodentl A ^ 1 ANY AUTO BODILY INJURY(Per person) 5 ALL OWMED I AUTOS SCHEDULED 60489279 H4/1/2019 4/1/2020 BODILY INJURY(Per 6Uioent) 5 • X HIREDAUTOS X NGN-OV NED (PROecoa DAMAGE 5 3 X UMBRELLA UAB X I OCCUR EACH OCCURRENCE I S 5.000,000 A EXCESS UAB I CLAIMS-MADE AGGREGATE IS 5,000,000 I DED X RETENTION S 0 60489279 4/1/2019 4/1/2020 15 WORKERS COMPENSATION X I STATUTE I I ETH I AND EMPLOYERS'LIABIUTY Y I N ANY PROPRIETORIPARTNERJEXECUTIVEE.L.EACH ACCIDENT 5 1,000,000 _A OFFICER(MEMBER EXCLUDED? - Y N I A (mandatory InNH) ' 60489279 .- 4/1/2019- -4/1/2020- E.L:DISEASE'EA EMPLOYEE'I-S /70007000 II yes,describe trifler DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I 5 1,000,000 B EQUIP BORROWED/LEASED/RENTED 1:240706541 4/1/2019 4/1/2020 100,000 PER ITEM FROM OTHERS 250.000 PER OCCURRENCE DESCRIPTION OF OPERATIONS(LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is rewind) CERTIFICATE HOLDER- CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Salina THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN PO Box 736 ACCORDANCE WITH THE POLICY PROVISIONS. Salina, KS 67402 AUTHORIZED REPRESENTATIVE Jolene Cooper/COOPJO q-ez.nt, I 0 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) • ACORD® - CERTIFICATE OF LIABILITY INSURANCE DATE TE(MWD ole/YYYY) 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 Jolene 'Coo er ; - ' NAME: P Insurance-Planning_Inc,_.__ _�_-'_._;______ __ ."Ci No,Ean:-(785)625-0819•.,., - • •- '(rc,Nol:mm625-0869 " " . 3006.Broadwa Avenue.., i E-MAIL coo o@insurance- Tannin -•;lA ! .Y' -:CL, c;;r , ADDRESS: p J -planning.corn P. :o Box 100 _ INSURER(S)AFFORDING COVERAGE ' I '' NICa A " • Hays . - -. .^ KS .67601 INSURER A:Addison Insurance Company 10324 INSURED M & D of Hays Inc INSURER B:RLI Insurance Company I D & M Investments LLC INSURER C: I INSURER D: PO Box 184 INSURER E: Hays XS 67601 INSURERF: I COVERAGES CERTIFICATE NUMBER:18/19 Certs REVISION NUMBER: _ I THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN.ISSUED TO THE INSURE D NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR.CONDITION OF ANY CONTRACT OF 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. ILSi-TitEXP TR TYPE OF INSURANCE h gplSWYDR l POLICY NUMBER I(MPMDDYIYYYY)EFFI IMMIDDYIYYYYI I LIMITS X I COMMERCIAL GENERAL LIABILITY • EACH OCCURRENCE 15 1,000,000 A I CLAIMS-MADE X OCCUR PRMAGES aENTED DA PREMISES occurrence)oNence) S 100,000 I 60493569 11/10/2018 11/10/2019 MEDEXP(Any one person) S 5,000 . ._ PERSONAL BADV INJURY 15 1,000,000 • GENL AGGREGATE LIMIT APPLIES PER: _ _ - __ _ _ _- GENERAL AGGREGATE Is 1'2,600,000 POLICY1 X I JETV LOC PRODUCTS COMP/OPAGG 5 • 2,000,000 OTHER: 7 ' - '•I - I S AUTOMOBILE LIABILITY ' P' [ - ' :{• a COMBINED SINGLE WAR:+aI S C` + . 1,000,000 ✓• ' . _ ' .^"''-(_ BODILY INJURY(Per person) 5 ALLOWNED Mt-SCHEDULED:'::- c - I AUTOS - .AUTDS 60493569 11/10/2018 11/10/2019 BODILY INJURY(Per aaJden0I5 'NON . X :HIRED AUTOS ' • IAUTOS .-5'7:-/.. -5'7 •. .. • '(Per accident) P¢ERETeYml M- e " . - SAGE IS A X UMBRELLA LIAR I X OCCUR I EACH OCCURRENCE i 5 5,000,000 EXCESS DAB CLAIMS-MADE AGGREGATE S 5,000,000 •I I DED I X I RETENTIONS •- 0 I 60483569 11/10/2018 11/10/2019 1 5 WORKERS COMPENSATION - PER 0TH- ANDEMPLOYERS'LIABILITY YIN X I STAME I I ER • I • ANY PROPRIETOR/PARTNER/EJ(ECUTIVE NIA • E.L.EACH ACCIDENT I S 1,000,000 OFFICER/MEMBER EXCLUDED? I Y A (Mandatory In NH) 60483569 11/10/2018 11/10/2019 E.L.DISEASE-EA EMPLOYEES 1,000,000 - (yes,describe unlet IUESCRIPnON OF OPERA110MS below ( I- -- , — -, , cLvDISEAGL-PCLICVLIi,::T 15 - Iv500it.t0C - - B Equip Leased/Rented from Ot 11610704786 11/10/2018 11/10/2019 250,0001vnd • DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,AddlUonal Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Salina THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 736 ACCORDANCE WITH THE POLICY PROVISIONS. Salina, KS 67402 __ AUTHORIZED REPRESENTATIVE Jolene Cooper/COOPJO ' 15.-t_e t---enst--" ` C5 7-- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) £ L: . • 1ACDR D::' CERTIFICATE OF LIABILITY INSURANCE-. . .- -_ _. °ATE,MMDDYYYY,;.., -..,rR• . 3/29/2018:•. 7: .i---IF $-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-H 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. IfSUBROGATION 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:: . ,1—certificate-holder'In-lieu-°fsuch endorsement(s):'-' —- — - - - - -" - ' - "- - ""' "- -- PRODUCER 1 PRODUCER.. . _ _ CONTACT ._ _ __ . :-.-7I-_.._ --.7 •.,IC.. � -I L)C NAME: Jolene Cooper . .,. -i.::-.-7i.. � . Insurance_Plaania • ; Inc,,;, I I PHONE - (785)625-0619' q,;, .. FAX -.(785)615-0669;,.:.ur, IEMAIL 3006--Broadway'"Avenue--""----! • EMAILADDRESS:coopjo@insurance-planaingTcami.E T; ,;.,„y°„L, . INSURER(S)AFFORDING COVERAGE-'"'' --77:— 'I- _NAI.a:'..'.` -- -_•XS_ 67601 , - Hays--T—! ::r::! +.^^'_ _. wSURERA:Addison Insurance Company' • - 310324'9';1 INSURED-:.--_ . ., ,_ _ - . INSURER El:EL/ Insurance Company ' 2.1.;&"DExcavating InC ' '• •f " - INSURER C: Dirt. Diggers LLC - • INSURER O: I PO Box 184 - INSURERE: I • Hays • KS 67601 INSURERF: I I COVERAGES: - CERTIFICATE NUMBER:18/19 Certs. 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. ILTRI TYPE OF INSURANCE I°NS➢'$WVDI POLICY NUMBERPOUCEXP I(MM/DDY/YYYY)I(MM/ODEFFY/YYYY) LIMITS . I X I COMMERCIAL GENERAL LABILITY EACH OCCURRENCE 15 , 1,000,000 I- - DAMAGE TO RENTED =- 100,000 A.I I CLAIMS-MADE X OCCUR - ''. - -- - PREMISES(Ea occurrence) IS •• r— 60489279 4/1/2018 4/1/2019(�'MEDEXP(Any cnt ,0 e person) IS :500 ( _y _ _ c. PERSONALSADV INJURY IS 1,000,DCO . -z).GENLAGGREGATELLMIT APPLIES PER: - GENERAL AGGREGATE '-I S el4 2.000 000 ^I X.I,POLK:Y( - I JECT LOC �,-,_- _ .^ - ._ PRODUCTSy COMP/OP AGG 15 27000,000 e..I OTHER�",72r: dII AUTOMOBILE LIABNTY•;;,•g n�,. _ _ _ lOMBI ESSINGLE LIMB 4 I's' L; 1,000,000 A�a�ANYAUTO a :-:.;...,:rz: . '. • „- _ .___ BODILY INJURY(Perperson) IS' I :':A,LLGA44E0 I SCHEDULED 60489279 4/1/2018 4/1/2019 BODILY INJURY(Per accident)I S 1 AUTOS ' I AUTOS s NON-0VJNED .S PROPERTY DAMAGE ` Eiji'141nEDAUT05 I X AUTO$ ,1. - _.. _ -• , (Pa accident) i 5 Tfl X'I'UMBRELLA IJAS' I X' OCCUR I • EACH OCCURRENCE ii. -5,0-66,0-0-6 .A.•T C is9s,s DAB I C AIMS-M1NDEI)” (`AGGREGATE I S. 5,000,006 I i DEO.I`X I RETENTION5 0 I 60489279 4/1/2018 4/1/2019 I I S WORKERS COMPENSATION I X I PER I I DTH- I AND EMPLOYERS'IJABIUTY STATUTE ER Ylt! ANY PROPRIETOR/PARTNER/EXECUTIVE' E.L.EACH ACCIDENT I S 1,000,000 �. 'Mandatory^ I Fvpl+� - -- Y I NlA ___..__ — - -- A es.describe NH) i 60489279 4/1/2018 4/1/2019 TEL DISEASE-EA EMPLOYEjS 1,000,000 II yes,RIPTION Mer DESCRIPTION OF OPERATIONS bebw TEL DISEASE-POLICY LIMIT 5 1,000,000 B EQUIPMENT LEASED/RENTED ILH0706541 4/1/2018 4/1/2019 250,000 LIMIT 'PROM-OTHERS DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) _CERTIFICATE HOLDER . CANCELLATION • SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE - City of Salina THE EXPIRATION DATE THEREOF, NOTICE WILL :BE "DELIVERED IN I FO Box 736 ACCORDANCE WITH THE POLICY PROVISIONS. Salina, KS 67402 AUTHORIZED REPRESENTATIVE Jolene Cooper/COOPJO c13-et—ni_ C-61J-. ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) ACO - CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDIYYYY) 11/3/2017. 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 Jolene Cooper NAME: P Insurance Planning .Inc. PHONE (785)625-0819 IFA" (785)625-0669 _ - _(A/C,.Lo,.Eat): (AIC.No): 3006 Broadway-Avenue AIDRESS:coopjo@insurance-planning.com - - . . . P. O.' Box 100 INSURERIS)AFFORDING COVERAGE - - NAIC e Hays KS 67601 INSURER A:Addison Insurance Company 10324 INSURED M & D of Hays Inc INSURER ET:RI,/ Insurance Company . - D & M Investments LLC INSURERC: INSURER 0: PO Box 184 INSURER E Hays KS 67601 INSURER F: COVERAGES CERTIFICATE NUMBER:17/18 Certs REVISION NUMBER: THIS 15 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. IL SRI .TYPE OF INSURANCE IIAN501SWVD1 POLICY NUMBER I(MM/ODIYEYYY)FF I IMMIDDY/YYYY)EXP I LIMITS • X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1$ 1,000,000 DAMAGE TO RENTED 15 100,000 A -I CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) . I • 60483569 11/10/2017 11/10/20101 MED EXP(Anyone person) Is - 5.000 PERSONAL HADV INJURY 1$ - 1,000,000. I GENT AGGREGATE LIMIT APPLIES PER, GENERAL AGGREGATE- 15 2,000,000. I X I POLICY X JECT LOC PRODUCTS-COMP/OP AGO S - 2,000,000. -1 I OTHER: - $ 1 AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT S 1,000,000 • Ea acciaent) A I X I ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 60983569 11/10/2017 11/10/2018 BODILY INJURY(Per accgent) $ I /' AUTOS �_AUTOS I.X PROPERTHIRED AUTOS I X 1 AUT SWNED (Per accb nIDAMAGE g I . • 1 1- 5 X 1 UMBRELLA UAB 1 X 1 OCCUR I EACH OCCURRENCE 5 5,000;000 A EXCESS LIAR 1 ( CLAIMS-MADE AGGREGATE 5 5,000,000 1 DEO I X I RETENTIONS I 60483569 11/10/2017 11/30/20181 g WORKERS COMPENSATION AND EMPLOYERS'UABILITY YIN 1 X I STATUTE I I ERH ANY PROPRIETOR/PARTNERJEXECUTIVE1 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED' I y I NIA A (Mandan. in NH) —'—" -� —"60i-e3565 — -- 11"/1J/2017 lr/10/201 a'�E.L.DISEASE--EA EMPLOYER$1,000,000 II under DESCRIPTIOON OF OPERATIONS below I I OFFICER EXCLUDED I I E DISEASE-POLICY LIMIT 15 1,000,000 B Equip Leased/Rented from I1240704786 11/10/2017 11/10/2018 250,000LImrt Others DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Salina THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 736 ACCORDANCE WITH THE POLICY PROVISIONS. Salina, KS 67402 AUTHORIZED REPRESENTATIVE Jolene Cooper/COOPJO `CC2:SlrecTh— C—vCr- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(2DTt01) DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 11/7/2016 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). CONTACT PRODUCER Jolene Cooper NAME: FAX PHONE (785)625-0819(785)625-0869 Insurance Planning Inc. (A/C, No): (A/C, No, Ext): E-MAIL coopjo@insurance-planning.com 3006 Broadway Avenue ADDRESS: P. O. Box 100 INSURER(S)AFFORDINGCOVERAGENAIC# HaysKS67601 Addison Insurance Company10324 INSURER A : INSURED M & D of Hays Inc RLI Insurance Company INSURER B : D & M Investments LLC; Dirt Diggers LLC INSURER C : INSURER D : PO Box 184 INSURER E : HaysKS67601 INSURER F : 16/17 Certs COVERAGESCERTIFICATENUMBER:REVISIONNUMBER: 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. ADDLSUBR INSR POLICY EFFPOLICY EXP TYPE OF INSURANCELIMITS POLICY NUMBER LTR(MM/DD/YYYY)(MM/DD/YYYY) INSDWVD COMMERCIAL GENERAL LIABILITY X 1,000,000 EACHOCCURRENCE$ DAMAGE TO RENTED 100,000 CLAIMS-MADEOCCUR$ AX PREMISES(Eaoccurrence) 6048356911/10/201611/10/2017 5,000 MEDEXP(Anyoneperson)$ 1,000,000 PERSONAL&ADVINJURY$ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- X 2,000,000 POLICYLOCPRODUCTS - COMP/OP AGG$ JECT $ OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $ 1,000,000 (Eaaccident) BODILYINJURY(Perperson)$ X ANY AUTO A ALLOWNEDSCHEDULED BODILYINJURY(Peraccident)$ 6048356911/10/201611/10/2017 AUTOSAUTOS NON-OWNED PROPERTY DAMAGE $ XX HIRED AUTOS (Peraccident) AUTOS $ UMBRELLA LIAB XX EACHOCCURRENCE$ OCCUR 5,000,000 EXCESS LIAB CLAIMS-MADEAGGREGATE$ 5,000,000 A 11/10/2016 6048356911/10/2017 $ DEDRETENTION$ PEROTH- WORKERS COMPENSATION x STATUTEER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACHACCIDENT$ 1,000,000 N / A OFFICER/MEMBER EXCLUDED?Y 11/10/2016 A 6048356911/10/2017 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ 1,000,000 Ifyes,describeunder OFFICERS EXCLUDED E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS below 1,000,000 B Equip Leased/Rented from ILM070478611/10/201611/10/2017 250,000 Limit Others DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDERCANCELLATION 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 Salina, KS 67402 AUTHORIZED REPRESENTATIVE Jolene Cooper/COOPJO ©1988-2014ACORDCORPORATION.Allrightsreserved. ACORD25(2014/01)TheACORDnameandlogoareregisteredmarksofACORD INS025(201401) A� DATE(MM/DD/YYYY) ® CERTIFICATE OF LIABILITY INSURANCE 11/2/2015 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). CONTACT Jolene Cooper PRODUCER NAME: _ i - Insurance Planning Inc. PHONE (785)625-0819 FAX No): (785)625-0e69 g jA/C,No,Ext): 3006 Broadway Avenue E-MAIL coopjo @insurance-planning.com ADDRESS: .. __ . -- - - - P. 0. BOX 10 0 _ INSURER(S)AFFORDING COVERAGE NAIC# Hays KS 67601 INsuRERA:Continental Western Insur Co. 10804 INSURED NsuRERB:Indemnity Insurance Co of North 43575 _ M & D of Hays Inc INSURER C:RLI Insurance Company D & M Investments LLC; Dirt Diggers LLC INSURER 0: T_ PO Box 184 INSURER E: --__-_ __-- _-_ -r... Hays KS 67601 INSURERF: I COVERAGES CERTIFICATE NUMBER:15-16 Certs REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE FOLIC`( 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. - "--—-- --- `SUBR- - 1 POLICY EFF POLICY EXP ILTR TYPE OF INSURANCE I NSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1 $ 1,000,000 DAMAGE TO RENTED $ 100,000 A ' CLAIMS-MADE f X OCCUR PREMISES(Ea occurrence) _. __. I CPA237555133 11/10/2015 11/10/2016. MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY ' $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X .J POLICY Li PRO l LOC PRODUCTS-COMP/OPAGG $ 2,000,000 JECT OTHER. $ COMBINED SINGLE LIMIT $ 1,000,000 AUTOMOBILE LIABILITY COMBINED accident) A 1_ ANY AUTO W III BODILY INJURY(Per person) $ ---' ALL OWNED ,' —I SCHEDULED CPA237555133 11/10/2015'11/10/2016 BODILY INJURY(Per accident) $ AUTOS 1 AUTOS -- .- --_-- -� I--- PROPERTY DAMAGE 4 X I X AUTOS ED _Ter accidenq �_ HIRED AUTOS AUTOS --- --- $ I X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 B EXCESS LIAB 1 I CLAIMS-MADE AGGREGATE $ 5,000,000, _ - IiDED I X !RETENTION$ 10,000 [N10907032001 11/10/2015111/10/2016 $ 1 WORKERS COMPENSATION 1 PER I 1OTH �AND EMPLOYERS'LIABILITY Y/N X I STATUTE ER E L.EACH OFFICER/MEMBEER/EXCLUDED?ECUTIVE y— N/A WCA239020833 11/10/2015 11/10/2016 E L-._DISEASE CEA EMPLOYEE$___ _ 1,000,000 ANY A Mandator,/m NH) I If yes describe under OFFICERS EXCLUDED E.L.DISEASE-POLICY LIMIT 1 $ 1,000,000 DESCRIPTION OF OPERATIONS below C I Equip Leased/Rented from Others ILM0704786 11/10/2015 11/10/2016 250,000 Limit DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER -CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Salina THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 736 Salina, KS 67402 AUTHORIZED REPRESENTATIVE -� l�j�- Jolene Cooper/COOPJO C ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) • 11`'Lin Lg. CERTIFICATE OF LIABILITY INSURANCE DATE(NIM/°D/YYYY) 11/04/2014 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 - . .. . . ._ .. . • NAME: Insurance Planning, Inc. PHONN,ext): 785.625.5605 - FAX,No),785.625.8388• .3006 Broadway Avenue - - E-MAIL .. ADDRESS: - . P. "0. Box ' 109 PRODUCER CUSTOMER ID#: Hays, KS 67601 • INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA: Continental Western Insur Co. 10804 M & D of Hays Inc INSURERB: Berkley National Ins Co D & M Investments LLC INSURERC: Dirt Diggers LLC INSURERD: PO Box 184 INSURER E: Hays, KS 67601 INSURER F: COVERAGES CERTIFICATE NUMBER: 14/15 Certs 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 SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE N W SR S POLICY EFF POLICY EXP VD POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) LIMITS GENERAL LIABILITY CPA23755513211/10/2014 11/10/2015 EACH OCCURRENCE $ 1,000,001 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES LOO 000 PREMISES(Ea occurrence) � CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 1,000,001 GENERAL AGGREGATE . $ 2,000,001 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,001 POLICY • PRO LOC - $ JECT AUTOMOBILE LIABILITY - CPA237555132 11/10/2014 11/10/2015 COMBINED SINGLE LIMIT $ • (Ea accident) • . - —.1,000,001 X ANY AUTO - - BODILY INJURY-(Per person) $ • " - •.. ALL OWNED AUTOS BODILY INJURY(Per accident) $ - . - A SCHEDULED AUTOS PROPERTY DAMAGE . $ X HIRED AUTOS- - (Per accident)•X NON-OWNED AUTOS $ • $ UMBRELLA LIAB X OCCUR CPA23755513211/10/2014 11/10/2015 EACH OCCURRENCE $ 5,000,001 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,001 A - DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WCA239020833 11/10/2014 11/10/2015 X TORY LIMITS OTH- AND EMPLOYERS'LIABILITY ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICERS EXCLUDED E.L.EACH ACCIDENT $ 1,000,001 A OFFICER/MEMBER EXCLUDED? — -N./A --. — - - ! - --- _$_ _ __ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE 1,000;1)01 • If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,001 RENTED/LEASED EQUIPMENT FROM MIM100275311/10/2014 11/10/2015 $50,000 LIMIT B OTHERS DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) 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. 1 City of Salina-Utilities Dept Attn Martha Tasker, Director of Utilities AUTHORIZEDREPR - N�f:.IVE t : OF ,' ., PO Box 736 1I t7 , ,z Sallina, KS 67402-0736 ; ©-9: -2009 ACORD CORPORA '0N. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD