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Insurance CertificateDATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 09/28/2020 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 PRODUCER Amber Bell NAME: FAX PHONE Assurance Partners, LLC(800) 563-1871(785) 825-5098 (A/C, No): (A/C, No, Ext): E-MAIL 201 E Iron Avenueabell@yourassurance.com ADDRESS: P.O. Box 1213 INSURER(S) AFFORDING COVERAGENAIC # SalinaKS67402-1213Zurich American Insurance Company16535 INSURER A : INSURED MMIC Insurance, Inc. INSURER B : Salina Regional Health Center INSURER C : Salina Regional Health Properties, Inc. INSURER D : 400 S Santa Fe INSURER E : SalinaKS67401-4144 INSURER F : 20.21 SRHC Bond Issue COVERAGESCERTIFICATE NUMBER: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. ADDLSUBR INSRPOLICY EFFPOLICY EXP TYPE OF INSURANCELIMITS POLICY NUMBER LTR(MM/DD/YYYY)(MM/DD/YYYY) INSDWVD COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE$ DAMAGE TO RENTED 100,000 CLAIMS-MADEOCCUR$ PREMISES (Ea occurrence) 5,000 MED EXP (Any one person)$ AYHPC65547091110/01/202010/01/20211,000,000 PERSONAL & ADV INJURY$ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- 3,000,000 POLICYLOCPRODUCTS - COMP/OP AGG$ JECT $ OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $ (Ea accident) ANY AUTOBODILY INJURY (Per person)$ OWNEDSCHEDULED BODILY INJURY (Per accident)$ AUTOS ONLYAUTOS HIREDNON-OWNEDPROPERTY DAMAGE $ (Per accident) AUTOS ONLYAUTOS ONLY $ UMBRELLA LIAB 15,000,000 OCCUREACH OCCURRENCE$ A EXCESS LIAB HPC65547151110/01/202010/01/202115,000,000 CLAIMS-MADEAGGREGATE$ 25,000 DEDRETENTION$$ PEROTH- WORKERS COMPENSATION STATUTEER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT$ N / A OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under DESCRIPTION OF OPERATIONS belowE.L. DISEASE - POLICY LIMIT$ BMHP00044601/01/202001/01/2021 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Professional Employees of Salina Regional Health Center, Inc., other than Health Care Providers subj to KSA40-3401, are included for Professional Liability. KS Health Care Stabilization Fund limits - $800,000 per patient limit/$2,400,000 total limit. CERTIFICATE HOLDERCANCELLATION 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 P O Box 736 AUTHORIZED REPRESENTATIVE SalinaKS67402-0736 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 09/28/2020 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 PRODUCER Amber Bell NAME: FAX PHONE Assurance Partners, LLC(800) 563-1871(785) 825-5098 (A/C, No): (A/C, No, Ext): E-MAIL 201 E Iron Avenueabell@yourassurance.com ADDRESS: P.O. Box 1213 INSURER(S) AFFORDING COVERAGENAIC # SalinaKS67402-1213Zurich American Insurance Company16535 INSURER A : INSURED Nationwide Mutual Insurance Company23787 INSURER B : Salina Regional Health CenterSafety National Casualty Corporation15105 INSURER C : Salina Regional Health Properties, Inc. INSURER D : 400 S Santa Fe INSURER E : SalinaKS67401-4144 INSURER F : 20.21 SRHC City of Salina COVERAGESCERTIFICATE NUMBER: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. ADDLSUBR INSRPOLICY EFFPOLICY EXP TYPE OF INSURANCELIMITS POLICY NUMBER LTR(MM/DD/YYYY)(MM/DD/YYYY) INSDWVD COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE$ DAMAGE TO RENTED 100,000 CLAIMS-MADEOCCUR$ PREMISES (Ea occurrence) 5,000 MED EXP (Any one person)$ AYHPC65547091110/01/202010/01/20211,000,000 PERSONAL & ADV INJURY$ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- 3,000,000 POLICYLOCPRODUCTS - COMP/OP AGG$ JECT $ OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY 1,000,000 $ (Ea accident) ANY AUTOBODILY INJURY (Per person)$ OWNEDSCHEDULED BACP720067103810/01/202010/01/2021 BODILY INJURY (Per accident)$ AUTOS ONLYAUTOS HIREDNON-OWNEDPROPERTY DAMAGE $ (Per accident) AUTOS ONLYAUTOS ONLY $ UMBRELLA LIAB OCCUREACH OCCURRENCE$ EXCESS LIAB CLAIMS-MADEAGGREGATE$ DEDRETENTION$$ PEROTH- WORKERS COMPENSATION STATUTEER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT$ C N / A AGC406171101/01/202001/01/2021 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under DESCRIPTION OF OPERATIONS belowE.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Project: Fiber optic cable w/in public right of way– Comcare campus at 617 E Elm and Salina Regional Health Center data center. CERTIFICATE HOLDERCANCELLATION 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 SalinaKS67401 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 09/28/2020 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 PRODUCER Amber Bell NAME: FAX PHONE Assurance Partners, LLC(800) 563-1871(785) 825-5098 (A/C, No): (A/C, No, Ext): E-MAIL 201 E Iron Avenueabell@yourassurance.com ADDRESS: P.O. Box 1213 INSURER(S) AFFORDING COVERAGENAIC # SalinaKS67402-1213Zurich American Insurance Company16535 INSURER A : INSURED Nationwide Mutual Insurance Company23787 INSURER B : Salina Regional Health CenterSafety National Casualty Corporation15105 INSURER C : Salina Regional Health Properties, Inc. INSURER D : 400 S Santa Fe INSURER E : SalinaKS67401-4144 INSURER F : 20.21 SRHC City of Salina COVERAGESCERTIFICATE NUMBER: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. ADDLSUBR INSRPOLICY EFFPOLICY EXP TYPE OF INSURANCELIMITS POLICY NUMBER LTR(MM/DD/YYYY)(MM/DD/YYYY) INSDWVD COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE$ DAMAGE TO RENTED 100,000 CLAIMS-MADEOCCUR$ PREMISES (Ea occurrence) 5,000 MED EXP (Any one person)$ AYHPC65547091110/01/202010/01/20211,000,000 PERSONAL & ADV INJURY$ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- 3,000,000 POLICYLOCPRODUCTS - COMP/OP AGG$ JECT $ OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY 1,000,000 $ (Ea accident) ANY AUTOBODILY INJURY (Per person)$ OWNEDSCHEDULED BACP720067103810/01/202010/01/2021 BODILY INJURY (Per accident)$ AUTOS ONLYAUTOS HIREDNON-OWNEDPROPERTY DAMAGE $ (Per accident) AUTOS ONLYAUTOS ONLY $ UMBRELLA LIAB OCCUREACH OCCURRENCE$ EXCESS LIAB CLAIMS-MADEAGGREGATE$ DEDRETENTION$$ PEROTH- WORKERS COMPENSATION STATUTEER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT$ C N / A AGC406171101/01/202001/01/2021 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under DESCRIPTION OF OPERATIONS belowE.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Project: Fiber optic cable w/in public right of way–Kenwood Park Dr and Salina Regional Health Center Data Center. CERTIFICATE HOLDERCANCELLATION 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 SalinaKS67401 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 09/28/2020 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 PRODUCER Amber Bell NAME: FAX PHONE Assurance Partners, LLC(800) 563-1871(785) 825-5098 (A/C, No): (A/C, No, Ext): E-MAIL 201 E Iron Avenueabell@yourassurance.com ADDRESS: P.O. Box 1213 INSURER(S) AFFORDING COVERAGENAIC # SalinaKS67402-1213Zurich American Insurance Company16535 INSURER A : INSURED Nationwide Mutual Insurance Company23787 INSURER B : Salina Regional Health CenterSafety National Casualty Corporation15105 INSURER C : Salina Regional Health Properties, Inc. INSURER D : 400 S Santa Fe INSURER E : SalinaKS67401-4144 INSURER F : 20.21 SRHC City of Salina COVERAGESCERTIFICATE NUMBER: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. ADDLSUBR INSRPOLICY EFFPOLICY EXP TYPE OF INSURANCELIMITS POLICY NUMBER LTR(MM/DD/YYYY)(MM/DD/YYYY) INSDWVD COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE$ DAMAGE TO RENTED 100,000 CLAIMS-MADEOCCUR$ PREMISES (Ea occurrence) 5,000 MED EXP (Any one person)$ AYHPC65547091110/01/202010/01/20211,000,000 PERSONAL & ADV INJURY$ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- 3,000,000 POLICYLOCPRODUCTS - COMP/OP AGG$ JECT $ OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY 1,000,000 $ (Ea accident) ANY AUTOBODILY INJURY (Per person)$ OWNEDSCHEDULED BACP720067103810/01/202010/01/2021 BODILY INJURY (Per accident)$ AUTOS ONLYAUTOS HIREDNON-OWNEDPROPERTY DAMAGE $ (Per accident) AUTOS ONLYAUTOS ONLY $ UMBRELLA LIAB OCCUREACH OCCURRENCE$ EXCESS LIAB CLAIMS-MADEAGGREGATE$ DEDRETENTION$$ PEROTH- WORKERS COMPENSATION STATUTEER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT$ C N / A AGC406171101/01/202001/01/2021 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under DESCRIPTION OF OPERATIONS belowE.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Project: Fiber optic cable w/in public right of way–Donna Vanier Children’s Center and Salina Regional Health Center data center. CERTIFICATE HOLDERCANCELLATION 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 SalinaKS67401 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD ACERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 09/24/2019 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 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 NAME CONTACT Susan Flaming Assurance Partners PHONE (800)563-1871 FAX (785)825-5098 201 E Iron Avenue AE-MAIL Ext): (A/C,No): ADDRESS: Sflaming(�yOUraSSUranCe.COm P.O.Box 1213 INSURER(S)AFFORDING COVERAGE NAIC# Salina KS 67402-1213 INSURER A: Zurich American Insurance Company 16535 INSURED INSURER B: Nationwide Mutual Insurance Company 23787 Salina Regional Health Center INSURER C: self-insured Salina Regional Health Properties,Inc. INSURER D: 400 S Santa Fe INSURER E: Salina KS 67401-4144 INSURER F: COVERAGES CERTIFICATE NUMBER: 2019 SRHC City of Salina 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 SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO REN CED 100,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 A — Y HPC655470909 10/01/2019 10/01/2020 PERSONAL EADV INJURY $ 1,000,000 --GEN��'L AGGREGATE LIMIT APPLIES PER' GENERAL AGGREGATE $ 3,000,000 I POLICY PRO )ET LOC PRODUCTS-COMP/OP AGG $ 3,00 00 , 00 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED ACP7290671038 10/01/2019 10/01/2020 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HNON-OWND PROPERTY DAMAGE AUTOSIRED �—ONLY !� AUTOS ONLY $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION MUTE EMPLOYERS'LIABILITY Y/N X STATUTE ER C ANY PROPRIETOR/PARTNER/EXECUTIVE N/A self-insured 01/01/2019 01/01/2020 E.L.EACH ACCIDENT $ $1,000, 000 OFFICER/MEMBER EXCLUDED') (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project:Fiber optic cable w/in public right of way—Kenwood Park Dr and Salina Regional Health Center Data Center. 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 Salina KS 67401 ;-� I aY ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Aco CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) ‘,4m..------ 09/24/2019 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 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 Susan Flaming NAMEAssurance Partners PHONE (800)563-1871 FAX (785)825-5098 na No,Ext): (A/C,No): 201 E Iron Avenue ADDRESS: sflaming@yourassurance.com P.O.Box 1213 INSURER(S)AFFORDING COVERAGE NAIC# Salina KS 67402-1213_ INSURER : Zurich American Insurance Company 16535 INSURED INSURER B: Nationwide Mutual Insurance Company 23787 Salina Regional Health Center INSURER c: self-insured Salina Regional Health Properties,Inc. INSURER D: 400 S Santa Fe INSURER E: Salina KS 67401-4144 INSURERF: COVERAGES CERTIFICATE NUMBER: 2019 SRHC City of Salina 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 AUUL SUBI( POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBERMM/DD/YYYY ( ) (MMIDD/YYYY) LIMITS X COMMERCIAL GENERALLIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR DAMAGE 10 RENTED 100,000 PREMISES(Ea occurrence) $ _ MED EXP(Any one person) $ 5,000 A Y HPC655470909 10/01/2019 10/01/2020 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 PRO X POLICY PRODUCTS $ _ JECT LOC 3,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) _ X ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED ACP7290671038 10/01/2019 10/01/2020 BODILYINJURY(Per accident) $ AUTOS ONLY AUTOS X AHX NON- WND PROPERTY DAMAGE $ UTOSIRED ONLY _ AUTOS OONLEY (Per accident) _ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE _ $ _ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY X STATUTE ER YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ $1,000,000 C OFFICER/MEMBER EXCLUDED? N/A self-insured 01/01/2019 01/01/2020 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project:Fiber optic cable w/in public right of way—Donna Vanier Children's Center and Salina Regional Health Center data center. 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 D�,,' +,�''�. Salina KS 67401 .......\ � /�J C/ I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ACo® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 09/24/2019 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 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 Susan Flaming NAME: Assurance Partners PHONE (800)563-1871 FAX (785)825-5098 Ext): (A/C,No): 201 E Iron Avenue A-MAIL sflaming@yourassurance.com ADDRESS: P.O.Box 1213 INSURER(S)AFFORDING COVERAGE NAIC# Salina KS 67402-1213INSURERA: Zurich American Insurance Company 16535 INSURED INSURER B: Nationwide Mutual Insurance Company 23787 Salina Regional Health CenterINSURER C: self-insured Salina Regional Health Properties,Inc. INSURER D: 400 S Santa Fe INSURER E: Salina KS 67401-4144 INSURER F: COVERAGES CERTIFICATE NUMBER: 2019 SRHC City of Salina 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 INSD WVD POLICY NUMBER (MM/DDM/YY) (MMIDD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR DAMAGETO RENTED 100,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 A Y HPC655470909 10/01/2019 10/01/2020 PERSONAL&ADVINJURY _�$ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 3,000,000 PRO 00000X POLICY JECT LOC PRODUCTS $ , 0 _ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED ACP7290671038 10/01/2019 10/01/2020 BODILYINJURY(Peraccident) $ AUTOS ONLY AUTOS X HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY /� AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ WORKERS COMPENSATION X STATUTE EORH AND EMPLOYERS'LIABILITY C ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N N/A self-insured 01/01/2019 01/01/2020 E.L.EACH ACCIDENT $ $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ $1,000,000 If yes,describe under $1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project:Fiber optic cable w/in public right of way—Comcare campus at 617 E Elm and Salina Regional Health Center data center. 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 Salina KS 67401 *441-4„4 ,, ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ,4co CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 09/24/2019 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 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 Brenda Smith NAME: Assurance Partners PHONE (800)563-1871 FAX (785)825-5098 (A/C,No,Ext): (AIC,No): 201 E Iron Avenue n-DRESS: bsmith@yourassurance.com P.O.Box 1213 INSURER(S)AFFORDING COVERAGE NAIL# Salina KS 67402-1213 INSURER : Zurich American Insurance Company 16535 INSURED self-insured INSURER B: Salina Regional Health Center INSURER C: Salina Regional Health Properties,Inc. INSURER o: 400 S Santa Fe INSURER E: Salina KS 67401-4144 INSURER F: COVERAGES CERTIFICATE NUMBER: 19-20 SRHC Bond Issue 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 AUUL-SUHH POLICY EFF LICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM D /Y DY Y) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO REN 1 ED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A Y HPC655470909 10/01/2019 10/01/2020 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 PRO 00000X POLICY JECT LOC PRODUCTS-COMP/OPAGG $ 3, , OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ -� AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) _ X UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 15,000,000 A EXCESSLIAB CLAIMS-MADE HPC655471509 10/01/2019 10/01/2020 AGGREGATE $ 15,000,000 DED X RETENTION$ 25,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Per Patient $200,000 Professional Liability B self-insured 01/01/2019 01/01/2020 Aggregate $600,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Professional Employees of Salina Regional Health Center,Inc.,other than Health Care Providers subj to KSA40-3401,are included for Professional Liability. KS Health Care Stabilization Fund limits-$800,000 per patient limit/$2,400,000 total limit. 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. P 0 Box 736 AUTHORIZED REPRESENTATIVE Salina KS 67402-0736 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ACO® CERTIFICATE OF LIABILITY INSURANCE DATE`MMD°YYYY) �.------ 09/27/2018 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 CONTACT Brenda Smith NAME: Assurance Partners PHONE ) FAX (785)825-5098 ('AIC,No,Ertl: (800 563-1871 (� No): 201 E Iron Avenue ADMAess: bsmith@yourassurance.com' P.O.Box 1213 INSURER(S)AFFORDING COVERAGE NAIL a Salina KS 67402-1213INSURER A: Zurich American Insurance Company 16535 INSURED INSURERS: Nationwide Mutual Insurance Company 23787 Salina Regional Health CenterINSURER c: Self-Insured Salina Regional Health Properties,Inc. INSURER D: 400 S Santa Fe INSURER E: Salina KS 67401-4144 INSURER F: COVERAGES CERTIFICATE NUMBER: 2018 SRHC City of Salina 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 ADOCSUSR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IINSD,WVO POLICY NUMBER i(MMDDM'YY) (MMIDDIYYYY) LIMITS X COMMERCIAL GENERAL LIABIUTY 1,000,000 EACH OCCURRENCE 5 CLAIMS-MADE X OCCUR DAMAGE T O RENTED 50,000 PREMISES Ca occurrence S MED EXP(Any e person) 5 5,000 on A Y HPC655470909 10/01/2018 10/01/2019 PERSONAL&ADV INJURY 5 1.000.000 GENt AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY PEO n LOCPRODUCTS-COMP/OP AGG 3 3,000,000 — OTHER: S AUTOMOBILEUABIUTY COMBINED SINGLE UNIT s 1,000,000 (Ea accident, X ANY AUTO BODILY INJURY(Per person) 5 B OKNED SCHEDULED ACP7280671038 10/01/2018 10/01/2019 BODILY INJURY(Per accident) 5 AUTOS ONLY AUTOS HIRED NONSONLY PROPERTY DAMAGE X AU OS ONLY X AU OS ONLY (Per amdeml 3 5 UMBRELLA UAB OCCUR EACH OCCURRENCE 5 —^ EXCESS LIAB CLAIMS-MADE AGGREGATE S DEO RETENTION S5 WORKERS COMPENSATION • , X PER OTH- ANDEMPLOYER5WBnJTY YIN STATUTE ER C ANY PROPRIETOR/PARTNE_RiEXECUTIVE NIA Self-Insured 01/01/2018 01/01/2019 E L.EACH ACCIDENT 1.000000 OFFICERMEMBER EXCWDEDI (Mandatory In NH) E DISEASE-EA EMPLOYEE 3 1"1:),000 U yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below , E L_DISEASE-POLICY LIMIT S • DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Project:Fiber optic cable w/in public right of way—Comcare campus at 617 E Elm and Salina Regional Health Center data center. 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 Salina KS 67401 /I1ft I �! 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD ACORD® CERTIFICATE OF LIABILITY INSURANCE DATE 8 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 Brenda Smith NAME: Assurance Partners PHONE (800)563-1871 FAX (785)825-5098 (A/C No,Est): (A6,No): E 201 E Iron Avenue ADDRESS' bsmith@yourassurance.com P.D.Box 1213 INSURERS)AFFORDING COVERAGE NAIC tl Salina KS 67402-1213INSURER A: Zurich American Insurance Company 16535 INSURED INSURER B: Nationwide Mutual Insurance Company 23787 Salina Regional Health Center INSURER C: Self-Insured Salina Regional Health Properties,Inc. INSURER o: 400 S Santa Fe INSURER E: Salina KS 67401-4144 INSURER F: COVERAGES CERTIFICATE NUMBER: 2018 SRHC City of Salina 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. INSRADOL UBR POLICY EFF POLITY'EXP LTR TYPE OF INSURANCE I INSD WVD POLICY NUMBER (M WOO/MY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERALUABILITY 1,000,000 EACH OCCURRENCE 5 CLAIMS-MADE n OCCUR DAMAGE,O REN,ED 50,000 PREMISES(Ea occurrence) 5 MED EXP(Any me person) $ 5.000 A Y HPC655470909 10/01/2018 10/01/2019 PERSONAL ADV INJURY $ 1.000.000 GENT-AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 PROri POLICY ECT OC PRODUCTS-COMP/OP AGG 5 3.000.000 I OTHER: • S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED ACP7280671038 10/01/2018 10/01/2019 BODILY INJURY(Per accident) 5 AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE X AU OS ONLY X AUTOS ONLY (Per accident) $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS DAB CLAIMS-MADE AGGREGATE 5 DED RETENTION 5 $ WORKERS COMPENSATION ;MUTE X STATUTE ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT 5 1.000,000 C OFFICERIMEMBER EXCLUDED? n N/A Self-Insured 01/01/2018 01/01/2019 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 1.000.000 It yes,deunbe under - 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 5 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more apace Is required) Project:Fiber optic cable w/in public right of way—Kenwood Park Dr and Salina Regional Health Center Data Center. 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 REPRESENTATIVES / ,t Salina KS 67401 f/ /,Qa,,,a/, ( cw^-v�—��I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ACO® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY' �------- 09/27/2018 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 CONTACT Brenda Smith NAME: Assurance Partners PHONE ,Em): (800)563-1871 �� epi: (785)825-5098 201 E Iron Avenue E-MAILDESS: bsmith@yourassurance.com P.O.Box 1213 INSURER(S)AFFORDING COVERAGE NAIC ii Salina KS 67402-1213 INSURER A: Zurich American Insurance Company 16535 INSURED INSURER B: Nationwide Mutual Insurance Company 23787 Salina Regional Health Center INSURER c: Self-Insured Salina Regional Health Properties,Inc. INSURER D: 400 S Santa Fe INSURER E Salina KS 67401-4144 INSURERF: COVERAGES CERTIFICATE NUMBER: 2018 SRHC City of Salina 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. LIR TYPE OF INSURANCE NSDL WVD POLICY NUMBER POLICY EFF POLICY EXP (MOLICIYEFF {POLICYYP) UMITS X COMMERCIAL GENERALLABIUTY 1,000,000 EACH OCCURRENCE S CLAIMS-MADE X OCCUR DAMAGES O HENT ED 50,000 PREMISES(Ea occurrence) 5 MED EXP(Any one person) $ 5.000 A Y HPC655470909 10/01/2018 10/01/2019 PERSONAL SADV INJURY 5 1.000.000 � GEN�L AGGREGATE LIMIT APPUES PER: GENERAL AGGREGATE 5 3,000,000 Jll POLICY n jERa LOCPRODUCTS-COMP/OP AGG 5 3,000,000 OTHER: S • • AUTOMOBILE WBRJtt I COMBINED SINGLE LIMIT $ 1,000,000 (Ea athdent) X ANY AUTO BODILY INJURY(Per person) 5 B OWNED SCHEDULED ACP7280671038 10/01/2018 10/01/2019 BODILY INJURY(Per accident) S AUTOS ONLY _ AUTOS HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY JPer accident) 5 S UMBRELLA UAB OCCUR EACH OCCURRENCE 5 EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION S S I WORKERS COMPENSATION PER 0TH- ANOEMPLOYER5LABIUtt YIN X STATUTE ER C ANY PROPRIETOR/PARTNER/EXECUTIVE NIA Self-Insured 01/01/2018 01/01/2019 E.L.EACH ACCIDENT 5 1.000,000 OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE 5 1,000,000 II yes.describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be scathed if more space is required) Project:Fiber optic cable w/in public right of way—Donna Vanier Children's Center and Salina Regional Health Center data center. 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 ,` - Salina KS 67401Q/i�(,Q,l . I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AC D CERTIFICATE OF LIABILITY INSURANCE DAE`M'D°°" " 09/21/2017 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 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 Brenda Smith NAME: Assurance Partners PHONE (800)563-1871 SAX (785)825-5098 AIC No,Ealb (AIC,NO: 201 E Iron Avenue ADbsrnith@yourassurance.com ADDRESS: P.O.Box 1213 INSURER(S)AFFORDING COVERAGE NAIL• Salina KS 67402-1213 INSURER A: Zurich American INSURED INSURER e: Self-Insured Salina Regional Health Center INSURER C: Salina Regional Health Properties,Inc. INSURER D: 400 S Santa Fe INSURER E Salina KS 67401-4144 INSURERF: COVERAGES CERTIFICATE NUMBER: 2017 SRHC Bond Issue 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. W RR TYPE OF INSURANCE INSD yyyp POLICY NUMBER POLICY EFF POLICY EXP UMITS (MOLICY FF') ( ONDYYEXP X COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE S 1.000,000 DAJAAGc,O nth. D 50,000 CLAMS-MADE OCCUR PREMISES(Ea owsrencel S MED EXP(Any one S 5'000 a A Y HPC655470908 10/01/2017 10/01/2018 PERSONAL S ADPINNRY S 1,000,000 GGEEINL AGGREGATE UMIT APPLIES PER: GENERAL AGGREGATE S 3,000,000 POLICY f PRO �I 3,000,000 _ JECi IIOC PRODUCTS-COMPIOPAGG S OTHER: S COMBINED SINGLE LIMIT AUTOMOBILE UABNTY S _ (Ea amtlem) ANY AUTO BODILY INJURY(Per person)— S OWNED SCHEDULED BODILY INJURY(Per amdan) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOSS _ AUTOS ONLY _ AUTOS ONLY (Pet ascent) X UMBRELLA UAB OCCUR EACH OCCURRENCE S 15.000,000 A EXCESS MEI X CLAIMS-MADE HPC655471508 10/01/2017 10/01/2018 AGGREGATE S 15,000,000 DED X RETENTION S 25.000 S WORKERS COMPENSATION PER OTH- ANDEMPLOYERS'LIABIUTY YIN STATUTE ER ANY PROPRIETORIPARTNERIEXECUTNE ❑ NIA E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED'! (Mandatory In NH) EL.DISEASE-EA EMPLOYEE S If yea,detente under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT S Per Patient $200,000 Professional Liability B Self-Insured 10/01/2017 10/01/2018 Aggregate 5600,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If mon space Is required) Professional Employees of Salina Regional Health Center,Inc.,other than Health Care Providers sub)to KSA40-3401,are included for Professional Liability. KS Health Care Stabilization Fund limits-5800,000 per patient limit/S2,400,000 total limit. 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. PO Box 736 AUTHORIZED REPRESENTATIVE ///� �',,�� " Salina KS 67402-0736 '6�'8'e�/ ®1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AC® CERTIFICATE OF LIABILITY INSURANCE DATE E9212 017 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 Brenda Smith NAME: Assurance Partners PHONE (800)563-1871 FAX (785)825-5098 (AC,No,EMI: (A ,Na): y 201 E Iron Avenue P0DRESS: bswith@yourassurance.com P.D.Box 1213 INSURERIS)AFFORDING COVERAGE NAILS Salina KS 67402-1213 INSURER A: Zurich American INSUREDINSURER B: Nationwide Mutual Insurance Company 23787 • Salina Regional Health CenterINSURER C: Self-Insured Salina Regional Health Properties.Inc. INSURER 0: 400 S Santa Fe INSURER E Salina KS 67401-4144 INSURER F: COVERAGES CERTIFICATE NUMBER: 2017 City of Salina COI 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 L UNH POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY) (MMIDDIYYYY) LIMITS X COMMERCIAL GENERAL LMBIUTY EACH OCCURRENCE S 1,000,000 DAMACL TO RcNTtO 50,000 CLAIMS-MADE n OCCUR PREMISES(Ea ommence) $ MED EXP(My one person) S 5,000 A Y HPC655470908 10/01/2017 10/01/2018 PERSONAL SADV INJURY $ 1,000,000 GENIAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 3,000,000 XI POUCY IEC LOC PRODUCTS-COMP OP AGG S 3,000,000 OTHER: S AUTOMOBILE revue TY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident, X ANY AUTO BODILY INJURY(Per person) S g OWNED SCHEDULED ACP7270671038 10/01/2017 10/01/2018 BODILY INJURY(Per accident) AUTOS ONLY AUTOS _ HIRED AUTOS NED PROPERTY DAMAGE S X AUTOS ONLY X AUTOS ONLY (Per accident) $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS'LNBRITT X STATUTE OTH- ER YIN Q ANY PROPRIETORIPARTNERIEXECUTNE ❑ NIA Self-Insured 01/01/2017 01/01/2018 EL.EACH ACCIDENT S 1000000 OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L DISEASE-EA EMPLOYEE $ 1.000.000 LI yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 1e1,Additional Ranvrta Schedule,may be attached It man span is required) Project:Fiber optic cable w/in public right of way—Kenwood Park Dr and Salina Regional Health Center Data Center. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELNERED IN City of Salina ACCORDANCE WITH THE POLICY PROVISIONS. 300 W Ash AUTHORIZED REPRESENTATIVE ,,,,//// ''��,,,,,,LL''�� Salina KS 67401 a6//4/1414- 1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD A� E D CERTIFICATE OF LIABILITY INSURANCE DATE 01 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 Brenda Smith NAME: Assurance Partners PHONE (800)563-1871 FAX (785)825-5098 LAN,No.EA): (A/C,Nb): 201 E Iron Avenue EDIL bsmith(©yourassurance.com ADDRESS: P.O.Box 1213 INSUREWS)AFFORDING COVERAGE NMC• Salina KS 67402-1213wsuRERA: Zurich American INSUREDINSURER B: Nationwide Mutual Insurance Company 23787 Salina Regional Health CenterINsuRER C: Self-Insured Salina Regional Health Properties,Inc. INSURER D: 400 S Santa Fe INSURE0.E: Salina KS 67401-4144 INSURERF: COVERAGES CERTIFICATE NUMBER: 2017 City of Salina COI 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 CONDmONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD wVD POLICY NUMBER (MWDWYYYY) (NINNY/ YY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE3 1,000'000 DAMAGE TO Hob,nO 50,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) 3 — MED EXP(Any one person) S 5,000 ' A Y HPC655470908 10/01/2017 10/01/2018 PERSONAL&ADV INJURY S 1,000,000 GEENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 3,000,000 /ll POUCY 0¢T 0 LCC PRODUCTS-COMP/OP AGG S 3,000,000 I OTHER: 3 AUTOMOBILE uaaiuTT COMBINED SINGLE LIMIT 3 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) 3 B — OWNED SCHEDULED ACP7270671038 10/01/2017 10/01/2018 BODILY INJURY(Per aco0ent) S _ AUTOS ONLY AUTOS X HIREDAUTOS ONLY X AUTNONOS ONLY S NLY PROPERTY DAMAGE (Per amEeM) 3 3 UMBRELLA UAB OCCUR EACH OCCURRENCE S EXCESS UAB CLAIMS-MADE AGGREGATE S DED RETENTION S S WORKERS COMPENSATIONPER BTA AND EMPLOYERS'LABIUTY YIN X STATUTE ER C °FFICERryEMBER EXCLUDED)ANY PROPRIETORIPARTNERIEXECUTIVE ElNIA Self-Insured 01/01/2017 01/01/2018 EL EACH ACCIDENT S 1,000,000 (Mandatory In MI) E.L.DISEASE-EA EMPLOYEE S 1'000,000 If yes.describe under 1,000 A00 DESCRIPTION OF OPERATIONS babe/ EL DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule.may be attached if mon space Is requited) Project Fiber optic cable wfin public right of way-Donna Vanier Children's Center and Salina Regional Health Center data center. 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 ��alf//�(,/R�e-A'x I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ACORD® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 09/21/2017 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 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 Brenda Smith NAME: Assurance Partners PHONE (800)563-1871 FAX (785)825-5098 ''AIC No,EM): (AIC.No): 201 E Iron Avenue AOORess: bsmithEtyourassurance.com P.O.Box 1213 INSURER(5)AFFORDING COVERAGE NAW Salina KS 67402-1213 INSURER A: Zurich American INSURED INSURER 8: Nationwide Mutual Insurance Company 23787 Salina Regional Health CenterINSURER c: Self-Insured Salina Regional Health Properties,Inc. INSURER D: 400 S Santa Fe INSURER E: Salina KS 67401-4144 INSURER F: COVERAGES CERTIFICATE NUMBER: 2017 City of Salina COI 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 MY 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 AWL USN POLICY EFF POLICY EXP LTR TYPE OF INSURANCE LNSD WVD POLICY NUMBER (MWODIYYYY) (MMWOYYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE • S 1,000.000 DAMA4c JOtNI ED 50,000 CLAIMS-MADE El OCCUR PREMISES(Ea occurrence) S MED EXP(Any aro person) S 5,000 A Y HPC655470908 10/01/2017 10/01/2018 PERSONAL&ADV INJURY S 1.000,000 GENL AGGREGATE WAIT APPLIES PER: GENERAL AGGREGATE S 3,000,000 POLICY I 'jEd n LOC PRODUCTS-COMP/OPAGG S 3,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE UNJT S 1000000 (Ea sondem) X ANY AUTO BODILY INJURY(Per pence) S B OWNED --SCHEDULED ACP7270671038 10/01/2017 10/01/2018 BODILY INJURY(Pet accident) S AUTOS ONLY AUTOS HIREDNON-OWNED PROPERTY DAMAGE S X AUTOS ONLY X AUTOS ONLY (Per accident) UMBRELLA UAB OCCUR EACH OCCURRENCE S _ EXCESS LIAB CLAIMS-MADE AGGREGATE S OED RETENTIONS �/ S WORKERS COMPENSATION X S ANTE OTH- ER AND EMPLOYERS'LIABILITY Y IN G ANYPROPRIETORIPARTNERIEXECUTIVE I�I N/A Self-Insured 01/01/2017 01/01/2018 E.L.EACH ACCIDENT $ 1'�� OFFICER/MEMBER EXCLUDED') I I (mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 Il yes,describe under 1,000,000 DESCRIPTION OFOPERATIONSBICw E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be scathed if mon space Is required) Project:Fiber optic cable w/in public right of way—Comcare campus at 617 E Elm and Salina Regional Health Center data center. 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 1Q ltokaA l J' ©1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 9/30/2016 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 Brenda Smith NAME: FAX PHONE (800)563-1871(785)825-5098 Assurance Partners (A/C, No): (A/C, No, Ext): E-MAIL bsmith@yourassurance.com 201 E Iron St. ADDRESS: P.O. Box 1213 INSURER(S)AFFORDINGCOVERAGENAIC# SalinaKS67402-1213 Zurich American INSURER A : INSURED Self-Insured INSURER B : Salina Regional Health Center INSURER C : Salina Regional Health Properties, Inc. INSURER D : 400 S Santa Fe INSURER E : SalinaKS67401-4144 INSURER F : '16 SRHC GL,UMBR,PROF 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 50,000 CLAIMS-MADEOCCUR$ AX PREMISES(Eaoccurrence) HPC65547090710/1/201610/1/2017 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 $ OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $ (Eaaccident) BODILYINJURY(Perperson)$ ANY AUTO ALLOWNEDSCHEDULED BODILYINJURY(Peraccident)$ AUTOSAUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS (Peraccident) AUTOS $ UMBRELLA LIAB X EACHOCCURRENCE$ OCCUR 15,000,000 EXCESS LIAB CLAIMS-MADEAGGREGATE$ X 15,000,000 A 10/1/2016 X HPC65547150710/1/2017 $ 25,000 DEDRETENTION$ PEROTH- WORKERS COMPENSATION STATUTEER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACHACCIDENT$ N / A OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ Ifyes,describeunder E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS below B Professional Liability Self-Insured10/1/201610/1/2017 Per Patient$200,000 Aggregate$600,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) In addition self-insured limits for Professional Liabilty coverage is provided by the Kansas Health Care Stabilization Fund w/limits of $800,000 per patient/$2,400,000 total limit. Workers Compensation is self-insured and an Excess Workers Compensation policy is purchased through Safety National w/$1,000,000 maximum limit of indemnity per occurrence. CERTIFICATE HOLDERCANCELLATION coi@salina.org 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 Salina, KS 67401 AUTHORIZED REPRESENTATIVE Debbie Walker/DWALKE ©1988-2014ACORDCORPORATION.Allrightsreserved. ACORD25(2014/01)TheACORDnameandlogoareregisteredmarksofACORD INS025(201401) DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 9/29/2016 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 Brenda Smith NAME: FAX PHONE (800)563-1871(785)825-5098 Assurance Partners (A/C, No): (A/C, No, Ext): E-MAIL bsmith@yourassurance.com 201 E Iron St. ADDRESS: P.O. Box 1213 INSURER(S)AFFORDINGCOVERAGENAIC# SalinaKS67402-1213 Zurich American INSURER A : INSURED Self Insured INSURER B : Salina Regional Health Center INSURER C : Salina Regional Health Properties, Inc. INSURER D : 400 S Santa Fe INSURER E : SalinaKS67401-4144 INSURER F : 16 SRHC Bond Issue COI 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 50,000 CLAIMS-MADEOCCUR$ AX PREMISES(Eaoccurrence) X HPC65547090710/1/201610/1/2017 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 $ OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $ (Eaaccident) BODILYINJURY(Perperson)$ ANY AUTO ALLOWNEDSCHEDULED BODILYINJURY(Peraccident)$ AUTOSAUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS (Peraccident) AUTOS $ UMBRELLA LIAB X EACHOCCURRENCE$ OCCUR 15,000,000 EXCESS LIAB CLAIMS-MADEAGGREGATE$ X 15,000,000 A 10/1/2016 X HPC65547150710/1/2017 $ 25,000 DEDRETENTION$ PEROTH- WORKERS COMPENSATION STATUTEER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACHACCIDENT$ N / A OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ Ifyes,describeunder E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS below B Professional Liability SELF INSURED 10/1/201610/1/2017 Per Patient $200,000 Aggregate$600,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Professional Employees of Salina Regional Health Center, Inc., other than Health Care Providers subj to KSA40-3401, are included for Professional Liability. KS Health Care Stabilization Fund limits - $800,000 per patient limit/$2,400,000 total limit. CERTIFICATE HOLDERCANCELLATION coi@salina.org 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. P O Box 736 Salina, KS 67402-0736 AUTHORIZED REPRESENTATIVE Debbie Walker/DWALKE ©1988-2014ACORDCORPORATION.Allrightsreserved. ACORD25(2014/01)TheACORDnameandlogoareregisteredmarksofACORD INS025(201401)