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Insurance Certificate T ® DATE(MMIDDIYYYY) A�o CERTIFICATE OF LIABILITY INSURANCE 12/18/2020 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 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). CONTACT Lindsey Sturn PRODUCER NAME: Assurance Partners,LLC PHONE (800)563-1871 FAX No: (785)825-5098 (A/C,No,Ext): t ) 201 E Iron Avenue n-DRESS: Isturn@yourassurance.com P.O.Box 1213 INSURER(S)AFFORDING COVERAGE NAIC# Salina KS 67402-1213 INSURER A: Alliance of Nonprofits for Insurance 10023 INSUREDINSURER B: Accident Fund General Insurance Co 12304a OCCK,Inc. INSURER C: PO Box 1160 INSURER D: INSURER E: Salina KS 67402-1160 INSURER F: COVERAGES CERTIFICATE NUMBER: 21.22 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 500,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ ^MED EXP(Any one person) $ 20'000 A Y Y 2021-57506 01/01/2021 01/01/2022 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3'000'000 X POLICYn JEV PRCT LOC O PRODUCTS $ 3,000,000 ^/ OTHER: $ MB AUTOMOBILE LIABILITY CO aBI EDtj SINGLE LIMIT $ 1,000,000 (EaX ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED Y Y 2021-57506 01/01/2021 01/01/2022 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) _ $ X UMBRELLA LIABOCCUR EACH OCCURRENCE $ 2'000'000 A EXCESS LIAB CLAIMS-MADE 2021-57506-UMB 01/01/2021 01/01/2022 AGGREGATE $ 2'000'000 DED RETENTION$ $ STAT WORKERS COMPENSATION X UTE OTH- ER AND EMPLOYERS'LIABILITY Y l N 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE NIA Y 2000032044 01/01/2021 01/01/2022 E.L.EACH ACCIDENT $ B (Mandatory in N ) EXCLUDED? 500,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ It yes,describe under500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Occurence Limit $1,000,000 Professional Liability A 2021-57506 01/01/2021 01/01/2022 Aggregate Limit $3,000,000 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 THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Salina 300 W Ash AUTHORIZED REPRESENTATIVE XX/n��.�;; Salina KS 67401 y.(✓Icdri, ^' I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Additional Named Insureds Other Named Insureds Access Foundation of Kansas Non Prof Corp, Insured Multiple Names AFK Properties, LLC Not for profit org, Insured Multiple Names CLS of Saline County, Inc. Not for profit org, Insured Multiple Names Community Living of North Central Kansas Inc Not for profit org, Insured Multiple Names Disability Planning Organization of Kansas, Inc. Non Prof Corp, Insured Multiple Names OCCK Inc. Fiscal Agent Not for profit org, Insured Multiple Names OFAPPINF(02/2007) COPYRIGHT 2007,AMS SERVICES INC A� Y CERTIFICATE OF LIABILITY INSURANCE DATE(MAUDDDN 12/20/2018 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(les)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 Lindsey Stum NAME: Assurance Partners PHONE (800)563-1871 FAX (785)825-5098 IANC.No.Ertl: (A/C,No): 201 E Iron Avenue E-MAIL Isturn@yourassurance.com ADDRESS: P.O.Box 1213 INSURER(S)AFFORDING COVERAGE NAIL 6 Salina KS 67402-1213INSURER A: Philadelphia Indemnity Insurance Company 16058 INSUREDINSURER B: Accident Fund General Insurance Co 12304a OCCK,Inc. INSURER C: PO Box 1160 INSURER D: INSURER E: Salina KS 67402-1160 INSURER F: COVERAGES CERTIFICATE NUMBER: 19.20 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 AODL' USrl POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY) (MMIDD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 3 1,000,000 DAMAGE TO RENTED 100,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) 3 MED EXP(Any one person) 5 5.000 A Y PHPK1920545 01/01/2019 01/01/2020 PERSONALSADV INJURY 5 1,000,000 G��ENLAGGREGATEUMIT APPLIES PER: GENERAL AGGREGATE 5 3000000 31 POLICY n PRa 3,000,000 — JECT LOC PRODUCTS-COMPIOPAGG 5 OTHER: 5 AUTOMOBILE UABILITY COMBINED SINGLE MOT 5 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) 5 A OWNED SCHEDULED Y PHPK1920545 01/01/2019 01/01/2020 BODILY INJURY(Per accident) 5 AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE 5 AUTOS ONLY AUTOS ONLY (Per accident' 5 X UMBRELLA LIAR X OCCUR EACH OCCURRENCE 5 5,000,000 A EXCESSUAB CLAIMS-MADE y PHUB658611 01/01/2019 01/01/2020 AGGREGATE 5 5,000,000 DED X RETENTION S 10,000 S WORKERS COMPENSATION YIN X STATUTE ER BANY PROPRIETOR/PARTNER/EXECUTIVE NIA 2000022715 01/01/2019 01/01/2020 E.L.EACH ACCIDENT 5 500,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE 5 500,000 It yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 3 DESCRIPTION OF OPERATIONS/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 THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Salina ACCORDANCE WITH THE POLICY PROVISIONS. 300 WAsh - AUTHORIZED REPRESENTATIVE �j o< Salina KS 67401 -4:1ddU{ 1.1-' I V (' ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Additional Named Insureds Other Named Insureds Access Foundation of Kansas Non Prof Corp, Insured Multiple Names AFK Properties, LLC Not for profit org, Insured Multiple Names CLS of Saline County, Inc. Not for profit org, Insured Multiple Names Coctunity Living of North Central Kansas, Inc. Not for profit org, Insured Multiple Names Disability Planning Organization. of Kansas, Inc. Non Prof Corp, Insured Multiple Names OCCK Inc. Fiscal Agent Not for profit org, Insured Multiple Names OFAPPINF(02/2007) COPYRIGHT 2007,AMS SERVICES INC A�® CERTIFICATE OF LIABILITY INSURANCE DATE (MWDD1 ) 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 CONTACT Erin Burch NAME: Assurance Partners PHONE (800)563-1871 FAl( No.Ertl: (ANC,No): (785)825-5098 INC. 201 E Iron Avenue _ ADDRESS: eburoh@yourassurance.com P.O.Box 1213 INSURERIS)AFFORDING COVERAGE NAIC Y Salina KS 67402-1213 INSURER A: Philadelphia Indemnity Ins Co INSURED INSURER B: Accident Fund General Insurance Co 12304a OCCK,Inc. INSURER C: PO Box 1160 INSURERD: INSURER E: Salina KS 67402-1160 INSURER F: COVERAGES CERTIFICATE NUMBER: 18.19M 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 AODLbUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDDIYYYY) (MM/DD/YYYY) UMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 1.000,000 DAMAGE TO REN i ED 100.000 CLAIMS-MADE ni OCCUR PREMISES(Ea occurrence) 5 MED EXP(Any one personl $ 5.000 A Y PHPK1752368 01/01/2018 01/01/2019 PERSONAL&ADV INJURY 5 1.000.000 GEM_AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 5 3,000,000 X POLICY n Tei n LOC PRODUCTS-COMP/OPAGG $ 3.000,000 OTHER: Professional Liability $ 1,000.000 AUTOMOBILE UABILITY COMBINED SINGLE LIMIT S 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) S A OWNED SCHEDULED Y PHPK1752368 01/01/2018 01/01/2019 BODILY INJURY(Per accident) $ AUTOS ONLY _ AUTOS -- HIRED NON-OWNED PROPERTY DAMAGE 5 AUTOS ONLY _ AUTOS ONLY (Per accident) S X UMBRELLA UAB X OCCUR EACH OCCURRENCE 5 5,000,000 A EXCESS LIAR CLAIMS-MADE Y PHUB611157 01/01/2018 01/01/2019 AGGREGATE S 5,000,000 DED X RETENTION S 10,000 5 WORKERS COMPENSATION X STATUTE EORH AND EMPLOYERS'UABIUTY y'N ANY PROPRIETORIPARTNER/EXECUrIVE/ME.L.EACH ACCIDENT s 500,000 B OFFICER/MEMBER EXCLUDED? NIA 2000018724 01/01/2018 01/01/2019 --- - (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 5OQ000 If yes.describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 5 DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it mon 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 City of Salina ACCORDANCE WITH THE POLICY PROVISIONS. 300 WAsh AUTHORIZED REPRESENTATIVE <y,�{/���^� Salina KS 67401 (t2 II' 1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Additional Named Insureds Other Named Insureds Access Foundation of Kansas Non Prof Corp, Insured Multiple Names AFK Properties, LLC Not for profit org, Insured Multiple Names. CLS of Saline County, Inc. Not for profit org, Insured Multiple Names Community Living of North Central Kansas, Inc. Not for profit org, Insured Multiple Names Disability Planning Organization of Kansas, Inc. Non Prof Corp, Insured Multiple Names OCCK Inc: Fiscal Agent Not for profit org, Insured Multiple Names • OFAPPINF(02/2007) COPYRIGHT 2007,AMS SERVICES INC DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 12/30/2016 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 Alicia Weiland NAME: FAX PHONE (800)563-1871(785)825-5098 Assurance Partners (A/C, No): (A/C, No, Ext): E-MAIL aweiland@yourassurance.com 201 E Iron St. ADDRESS: P.O. Box 1213 INSURER(S)AFFORDINGCOVERAGENAIC# SalinaKS67402-1213 Philadelphia Indemnity Ins Co INSURER A : INSURED Accident Fund General Insurance Co12304a INSURER B : OCCK, Inc. INSURER C : PO Box 1160 INSURER D : INSURER E : SalinaKS67402-1160 INSURER F : 17.18 All Lines 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) X PHPK15952341/1/20171/1/2018 5,000 MEDEXP(Anyoneperson)$ 1,000,000 PERSONAL&ADVINJURY$ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- X 3,000,000 POLICYLOCPRODUCTS - COMP/OP AGG$ JECT Professional Liability$ 3,000,000 OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $ 1,000,000 (Eaaccident) BODILYINJURY(Perperson)$ X ANY AUTO A ALLOWNEDSCHEDULED BODILYINJURY(Peraccident)$ PHPK15952341/1/20171/1/2018 X AUTOSAUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS (Peraccident) AUTOS $ UMBRELLA LIAB XX PHUB568894 EACHOCCURRENCE$ OCCUR 5,000,000 EXCESS LIAB CLAIMS-MADEAGGREGATE$ 5,000,000 A 1/1/2017 XX 1/1/2018 $ 10,000 DEDRETENTION$ PEROTH- WORKERS COMPENSATION Bx STATUTEER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACHACCIDENT$ 500,000 N / A OFFICER/MEMBER EXCLUDED? 1/1/2017 20000160111/1/2018 (Mandatory in NH) YYYY E.L. DISEASE - EA EMPLOYEE$ 500,000 Ifyes,describeunder E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS below 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDERCANCELLATION COI@salina.orgCOI@salina.org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Salina City of Salina ACCORDANCE WITH THE POLICY PROVISIONS. 300 W Ash 300 W Ash Salina, KS 67401Salina, KS 67401 AUTHORIZED REPRESENTATIVE Alicia Weiland/AWEILAAlicia Weiland/AWEILA ©1988-2014ACORDCORPORATION.Allrightsreserved. ACORD25(2014/01)TheACORDnameandlogoareregisteredmarksofACORD INS025(201401) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/22/2014 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). CONTACT Alicia Weiland PRODUCER NAME: FAX Assurance Partners PHONE (800)563-1871 (785)825-5098 (A/C, No): (A/C, No, Ext): E-MAIL 201 E Iron St. aweiland@yourassurance.com ADDRESS: P.O. Box 1213 INSURER(S)AFFORDINGCOVERAGENAIC# SalinaKS67402-1213 Philadelphia Indemnity Ins Co INSURER A : Accident Fund General Insurance 12304a INSURED INSURER B : OCCK, Inc. INSURER C : PO Box 1160 INSURER D : INSURER E : SalinaKS67402-1160 INSURER F : 15.16 All but Crime 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 INSRPOLICY EFFPOLICY EXP TYPE OF INSURANCELIMITS POLICY NUMBER (MM/DD/YYYY)(MM/DD/YYYY) LTR INSRWVD 1,000,000 GENERAL LIABILITY EACHOCCURRENCE$ DAMAGE TO RENTED X 100,000 COMMERCIAL GENERAL LIABILITY$ PREMISES(Eaoccurrence) 1/1/20151/1/2016 A 5,000 X PHPK1271961 CLAIMS-MADEOCCURMEDEXP(Anyoneperson)$ 1,000,000 PERSONAL&ADVINJURY$ 3,000,000 GENERAL AGGREGATE$ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:PRODUCTS - COMP/OP AGG$ PRO- X $ POLICYLOC JECT COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY 1,000,000 (Eaaccident)$ X BODILYINJURY(Perperson)$ ANY AUTO A ALLOWNEDSCHEDULED PHPK1271961 1/1/20151/1/2016 BODILYINJURY(Peraccident)$ AUTOSAUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS (Peraccident) AUTOS $ XX 5,000,000 UMBRELLA LIAB EACHOCCURRENCE$ OCCUR 5,000,000 EXCESS LIAB A CLAIMS-MADEAGGREGATE$ X 1/1/20151/1/2016 PHUB484229 10,000 $ DEDRETENTION$ B WC STATU-OTH- WORKERS COMPENSATION X TORY LIMITSER AND EMPLOYERS' LIABILITY Y / N 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACHACCIDENT$ N / A OFFICER/MEMBER EXCLUDED? 1/1/20151/1/2016 2000009061 500,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ Ifyes,describeunder 500,000 E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Salina is listed as an additional insured with regard to general liabillity, auto & excess liability. A waiver of subrogation also applies in favor of the City of Salina, where allowed by state statute. THIS IS AN AMENDED CERTIFICATE AND SUPERCEDES ANY PREVIOUSLY ISSUED CERTIFICATE. CERTIFICATE HOLDERCANCELLATION COI@salina.org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Salina 300 W Ash AUTHORIZED REPRESENTATIVE Salina, KS 67401 Susan Flaming/SFLAMI ACORD25(2010/05)©1988-2010ACORDCORPORATION.Allrightsreserved. INS025 TheACORDnameandlogoareregisteredmarksofACORD (201005).01