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Insurance Certificate AFO® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDMYYI R 10131/2014 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 MARSH USA INC. NAME -... I FAX -- - PHONE l C No) TUTS .OK 74103-4016 03E,16 850 E-MAIL Ealf. _.. W TULSA.OK ]41➢3.4015 EMAIL INSURER(S)AFFORDING COVERAGE NAIC• 321229-GAWX-14-1S _ _ _ _ __ INSURER A:Associated Electric&Gas Ins Services Ltd 3190004 _— . INSURED INSURER B:ACE American Insurance Company ,2266) Kansas G Serape Company,a division ,N York Marne And General Insurance Company ' oI ONE Gas,Inc. INSURER C_ ear pany 15 E 5th Street INSURER DI _ Tulsa,OK 74103 __ INSURER E: __ INSURER F: , COVERAGES CERTIFICATE NUMBER: HOU-002331690-04 REVISION NUMBER:2 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWTHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT 00TH 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 TYPE OF INSURANCE INSR MPII POLICY NUMBER IMWLDOMRYI IMMIDDIWYI LIMITS LLR IDOL MP A GENERAL LIABILITY %L5350202P 11110112014 l 11/0112015 EACH OCCURRENCE )b 2,000.000 X DAM GE TOF€NTEO —_ NIP COMMERCIAL GENERAL LIABILITY PREMISES(E @ occurrence) b X I CLAIMS-MADE I .00CUR MEDEXP(Any me person) $ N/A % See Excess LrdGittly Below I PERSONAL B ADV INJURY $ Included X SIR$2,000.000 GENERAL AGGREGATE Is 2000000 GE_NL AGGREGATE LIMIT APPLIES PER. i PRODUCTS-COMP/OP AGO I E 2000030 ' X POLICY 170 , LOO I TS•AUTOMOBILE LIABILITY (Ea accident.)SINGLE LIMIT S •ANY AUTO I BODILY INJURY(Per person) $• 1 ALL OWNED SCHEDULED BODILY INJURY Peraw0enll $AUTOS •AUTOS NONDNMED C O ERTY DAMAGE y I HIRED AUTOS AUTOS I I 'jPer accolen0. I I S A UMBRELLA LIAO i I OCCUR XL5360202P 11101/2014 11161/2015 I EACH OCCURRENCE S 5000000 X EXCESS LIAR X (CLAIMS MADE . ,AGGREGATE S 5.000,000 OED , X ' RETENTION 520Q00 ' b B WORKERS COMPENSATION N N ' WLRC46O20069 !11)01,2014 -1110112015 % WC STATU- OTH •AND EMPLOYERS LIABILITY IORY_LIMITS. . Eft ) ANY PROPRETORPARTNE EXECUrVE Y N ' Does not apply to OK6 KS I E L E C ACCIDENT $ 2000000 OFFICER/MEMBER EXCLUDED? 2.000.000 (Mandatory In NH) E L DISEASE-EA EMPLOYEE 5 DESCRIPTION OF OPERATIONS berox 1,000000 E.L.DISEASE-POLICY LIMIT $ G Excess Workers Compensation WC2014EPP00356(OK&KS} 11/01/2014 11101(2015 (LIMITS STATUTORY 'SIR 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES NNalH ACORD 101,Addition Remarks schedule,If mon space is required) CERTIFICATE HOLDER CANCELLATION City of Salina Kansas SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO Box 736 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Selina,KS 67402-0736 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE or Mars USA Inc. David G.Wickberg —f.&t!/7—,—Q>! -- ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD AW CERTIFICATE OF LIABILITY INSURANCE DATE/2014 /YYYY) �/- 10131/2014 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 MARSH USA,INC. PHON: PHONE FAX 401 S BOSTON AVE.,STE 850 (A/C,No.Eat): IA/C,No): TULSA,OK 74103-4016 E-MAIL • ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# 321223–GAWX-14-15' INSURER A:Associated Electric&Gas Ins Services Ltd 3190004 INSURED ACE American Insurance Company 22667 Kansas Gas Service Company,a division • INSURER B of ONE Gas,Inc. INSURER C: New York Marine And General Insurance Company - 15 E 5th Street INSURER D: _ Tulsa,OK 74103 • INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: HOU-002287811-02 REVISION NUMBER:3 - 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. I S POLICY EFF POLICY EXP • LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER M/ LIMITS (MDD/YYYYI (MM/DD/YYYY) A GENERAL LIABILITY XL5360202P 11/01/2014 11/01/2015 EACH OCCURRENCE $ 2,000,000 X DAMAGE TO RENTED N/A COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ X CLAIMS-MADE _ OCCUR MED EXP(Any one person) $ N/A X See Excess Liability Below PERSONAL&ADV INJURY $ Included X SIR$2,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY JE0 LOC $ B AUTOMOBILE LIABILITY ISA H08829378 11/01/2014 .11/01/2015 -COMBINED-SINGLE-LIMIT - 2,000,000 (Ea accident) _ X ANY AUTO OK and KS are self Insured BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) $ A UMBRELLA LIAB OCCUR XL5360202P 11/01/2014 11/01/2015 EACH OCCURRENCE $ 5,000,000 X EXCESS UAB X CLAIMS-MADE AGGREGATE $ 5,000,000 DED X RETENTION$2,000,000 $ B• WORKERS COMPENSATION WLRC48020069 11/01/2014 11/01/2015 X WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N Does not apply to OK&KS E.L.EACH ACCIDENT $ 2,000,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 2,000,000 If yes,describe under 2,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Excess Workers Compensation • WC2014EPP00358(OK&KS) 11/01/2014 11/01/2015 LIMITS STATUTORY SIR 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) Certificate holder is added as Additional Insured(except Workers'Compensation)as required by written contract.General Liability is Primary and Non-Contributory as.respects to Additional Insureds.A Waiver of Subrogation is granted Certificate Holder as required by written contract.Insured is a qualified Self-Insured for Auto Liability in the state of OK and KS.OK#8300096,KS#4301473.XCU is not exduded. CERTIFICATE HOLDER CANCELLATION The City of Salina SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Clerk Office THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 736 ACCORDANCE WITH THE POLICY PROVISIONS. Salina,KS 67402-0736 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. David G.Wickberg --eZe7 — ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD