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Insurance Certificate
l ® DATE(MM/DD/YYYY) ACCORD CERTIFICATE OF LIABILITY INSURANCE 03/29/2021 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 Amber Bell NAME: Assurance Partners,LLC PHONE Ext): (800)563-1871 FAX(A/CNo): (785)825-5098 201 E Iron Avenue E-MAIL abell@yourassurance.com ADDRESS: P.O.Box 1213 INSURER(S)AFFORDING COVERAGE NAIC# Salina KS 67402-1213 INSURERA: Admiral Insurance Company 24856 INSUREDINSURER B: Nationwide Mutual Insurance Company 23787 Plains Environmental Services, Inc INSURER C: Accident Fund General Insurance Company 12304 1900 Tony's Rd INSURER D: INSURER E: Salina KS 67401-1749 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. NOTWTHSTANDING 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) (MMIDD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE R CLAIMS-MADE X OCCUR PREM SESO(Ea ENT D ence) $ 50,000 MED EXP(Any one person) $ 5,000 A Y Y FEIECC1369108 03/19/2021 03/19/2022PERSONAL&ADVINJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 X POLICY JECT PRO- LOC PRODUCTS-COMP/OPAGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) — X ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED Y ACP7200076469 03/19/2021 03/19/2022 BODILY INJURY(Per accident) $ AUTOS ONLY _ AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) X 19 $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A X EXCESS LIAB CLAIMS-MADE FEIEXS2259405 03/19/2021 03/19/2022 AGGREGATE $ 5,000,000 DED X RETENTION $ 0 $ WORKERS COMPENSATION X/ AND EMPLOYERS'LIABILITY /� STATUTE OTH- ER YIN 1 C ANY PROPRIETOR/PARTNER/EXECUTIVE NIA Y WCV6109809 03/19/2021 03/19/2022 E.L.EACH ACCIDENT $ , , OFFICER/MEMBER EXCLUDED? 1000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ , If yes,describe under 10 , 00000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ , Per Occurence $1,000,000 Contractor Pollution Liab A Professional Liability FEIECC13691 O8 03/19/2021 03/19/2022 Per Claim $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS 1 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 W.Ash AUTHORIZED REPRESENTATIVE � Salina KS 67401 4 Ol /�(J)e 1 .1P) Pi ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ACOREP CERTIFICATE OF LIABILITY INSURANCE DATE E(M8/2019 n 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) (A/C,Na,Ertl: INC,No): 825-5098 201 E Iron Avenue ADDRESS: Istum@yourassurance.com P.Q.Box 1213 INSURERISI AFFORDING COVERAGE NAIC s Sauna KS 67402-1213INSURER A: Admiral Insurance Company 248568 INSURED INSURER B: Nationwide Mutual Insurance Company 23787 Plains Environmental Services,Inc INSURER C: Accident Fund General Insurance Company 12304 1900 Tony's Rd INSURER D: INSURER E: Salina KS 67401-1749 INSURERF: 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 AUDI SUHK POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MWDD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 2'000.000 AMAG ADE n OCCUR DAMAGE iO REN I LD 50,000 CLAIMS -MADE (Ea omarence) 5 MED EXP(Any one pesos) 5 5,000 A Y Y FEIECC1369106 03/19/2019 03/19/2020 PERSONALS ADV INJURY _ S 2,000,000 GENLAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s 5,000,000 POLICY 1-1 PRo n 2,000,000 JECT LOC PRODUCTS-COMP/OP AGG 5 OTHER: s AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,000 aid IEa aer* X ANY AUTO BODILY INJURY(Per penal) $ g OWNED — SCHEDULED Y ACP7280076469 03/19/2019 03/19/2020 BODILY INJURY( AUTOS ONLY AUTOS PoraWbeN) $ X HIRED X NON-OWNED PROPERTY DAMAGE $ _ AUTOS ONLY _ AUTOS ONLY (Per accident) 19 S UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 5.000.000 A X EXCESS(JAB CLAIMS-MADE FEIEXS2259403 03/19/2019 03/19/2020 AGGREGATE $ 5,000,000 DED X RETENTION$ 0 $ WORKERS COMPENSATION PER OTH- ERAND EMPLOYERS'LIABILITY YIN X STATUTE G ANY PROPRIETOWPARTNER/EXECUTNE n NIA Y VYCV6109809 03/19/2019 03/19/2020 EL EACH ACCIDENT 7.000,000 Mantlato MEMBER EXCLUDED? 1,000,000 ( ry in NH) E L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT 5 Contractor Pollution Liab Per Occurence 55,000,000 A Professional Liability FEIECC1369106 03/19/2019 03/19/2020 Per Claim 55,000,000 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 City of Salina ACCORDANCE WITH THE POLICY PROVISIONS. 300 W.Ash AUTHORIZED REPRESENTATIVE �7 o Salina KS 67407 laa��{�i-"- tua- I VI ((II ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD A�® CERTIFICATE OF LIABILITY INSURANCE DAo3/lsno�s n 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 Lindsey Slum Assurance Partners PHONE (800)563-1871 FAX (785)825-5098 /A/C,No,Eat): (AIC,No): 201 E Iron Avenue EMAIL SS: IsturnI yourassurance.com ADDRE P.Q.Box 1213 INSURER(S)AFFORDING COVERAGE NAIC0 Salina KS 67402-1213INSURER A: Admiral Insurance Company 248568 INSURED INSURER B: Nationwide Mutual Insurance Company 23787 Plains Environmental Services,Inc INSURER C: Accident Fund General Insurance Company 12304 1900 Tonys Rd INSURER D: INSURER E: Salina KS 67401-1749 INSURER F COVERAGES CERTIFICATE NUMBER: 18.19 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 IW ADDLSUBR POLICY EFF (POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YY) On�YwTY)v� LIMITS O X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE5 2,000,000 CLAIMS-MADE nOCCUR DAMAGE TO ROTTED 50,000 PREMISES(Ea occurrence) 5 MED EXP(Arty Omen/one pon) S 5.000 A Y Y FEIECC1369105 03/19/2018 03/19/2019PERSONAL SADV INJURY $ 2.000,000 GENT AGGREGATE LIMIT APPLIES PER: 2,000,000 GENERAL AGGREGATE S PRO POLICY n JECi ri LOCPRODUCTS-COMPNPAGG 5 2.00 0.000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE WAIT S 1,000,000 JEa accident) X ANY AUTO BODILY INJURY(Per perscn) 5 g OWNED SCHEDULED Y ACP7270076469 03/19/2018 03/19/2019 BODILY INJURY Per accident) S AUTOS ONLY AUTOS ( 1 X AUTOS ONLY X AUTOS ONLY P(Per DAMAGE 5 19 5 UMBRELLA UAB X OCCUR EACH OCCURRENCE 5 2000,000 A X EXCESS UAB CLAIMS-MADE FEIEXS2259402 03/19/2018 03/19/2019 AGGREGATE S 2.000,000 DED X RETENTION 5 0 $ WORKERS COMPENSATION MUTE X STATUTE ER C ANY PROPRIETOR/EXCLUDED? Yn NIA Y WCV61098091 03/19/2018 03/19/2019 EL.EACH ACCIDENT IN 1.000.000 OFFICER/MEMBER EXCLUDED'! (Mandatory In NH) E.1 DISEASE-EA EMPLOYEE $ 1.000,000 II yes,describe ager 1,000,000 DESCRIPTION OF OPERATIONS below LI E.L.DISEASE-POLICY LIMIT 5 Contractor Pollution Liab Per Occurence 52,000,000 A Professional Liability FEIECC1369105 03/19/2018 03/19/2019 Per Claim 52,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD tet,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 SameACCORDANCE WITH THE POLICY PROVISIONS. 300 W Ash AUTHORIZED REPRESENTATIVE ,AQ�''^' Salina KS 67401 YAG II VI ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD A!-`�® DATE(MM/DD/YYYY)• V CERTIFICATE OF LIABILITY INSURANCE 4/3/2015 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- CONTACT Emily White .. - Assurance 'Partners_ PHONE Ext): (800)563-1871 ` - . No).-(785)825-5098":•-;--;- 201 E Iron St._ aooRess:ewhite @yourassurence.coln _ . ' - ----•- - ..- P.O. Box 1213 INSURERS)AFFORDING COVERAGE - NAIC N Salina l '. .:-;""`" ' ,. KS 67402-1213 INSURER A Admiral Insurance Company 24856 INSURED - - INSURERB:NatiOnwide Mutual Insurance Co 23787 Plains Environmental Services, DBA: Lynn Newcomer INSURER C:Travelers Indemnity 1900 Tony's Rd INSURER D: INSURER E: Salina KS 67401-1749 INSURERF: COVERAGES CERTIFICATE NUMBER:15/16 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 TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DDIYYYY) (MM(DD/YYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED A • CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ ' 50,000 000 . . i FEIECC1369102 3/19/2015 3/19/2016 MED FRCP(Any one person) $ 5,000- ; . • • . • . PERSONAL&ADV INJURY- $ 2,000,000" GEN'L AGGREGATE LIMB APPLIES PER: .GENERAL AGGREGATE $- 2-,000-;000' X POLICY PRO- 2,000,000 JECT LOG- PRODUCTS-COMP/OP AGG $ OTHER: Pollution Liability $ 2.,000,000 : AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ - 1,000,000 (Ea accident) B ANY AUTO • BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED ACP7240076469 3/19/2015 3/19/2016 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS R AUTOS (Per accident) — X t9 Uninsured motorist BI-single $ 1,000,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY-PROPRIETOR/PARTNER/EXECUTIVE-— - C - -- .___ _ E.L.EACH.ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N I A V (Mandatory In NH) WC 2281682 00 3/19/2015 3/19/2016 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 Contr Pollution-Ocurrence FEIECC1369102 3/19/2015 3/19/2016 2,000,000 ProfLiab-CM Retro:3/19/90 FEIECC1369102 3/19/2015 3/19/2016 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) City of Salina is named as an additional insured to General Liability. Waiver of Subrogation is added in favor of certificate holder to General Liability. 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 300 W. Ash ACCORDANCE WITH THE POLICY PROVISIONS. Salina, KS 67401 - AUTHORIZED REPRESENTATIVE - Emily White/EMILYW l.~34A" `- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) •