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Insurance Certificate A�D CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 2/11/2016 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). PRODUCER CONTACT STEPHENS INS REP NAME: Stephens Insurance, Inc. PHONE A/c.No.Extl; (785)841-9538 FAX AMA IL (A/C,No):(7851865-0623 2711 West 6th Street ADDRESS: Suite A INSURER(S)AFFORDING COVERAGE NAIC# Lawrence KS 66049 INsuRERANationwide Mutual Ins Co 23787 INSURED INSURERBAMCO Insurance Company 19100 LARSEN & ASSOCIATES INC INSURER C Depositors Insurance Company 42587 1311 E 25TH ST STE B INSURER D: INSURER E: LAWRENCE KS 66046-5010 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1621102706 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MMIDDYYY) (MM/DD/YYYY) X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED $ 100,000 A CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) ACPGL07272681145 5/5/2015 5/5/2016 MED EXP(Any one person) $ 1,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO 2,000,000 X POLICY JECT LOC LARGE PREMIUM $ OTHER: AUTOMOBILE LIABILITY COMBINED accideDiSINGLE LIMIT $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED AUTOS AUTOS ACPBA7272681145 5/5/2015 5/5/2016 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ __ HIRED AUTOS AUTOS (Per accident) . Schedule Mod Factor 1 $ X UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ 5,000,000 B EXCESS LIAB CLAIMS-MADE AGGREGATE 5 5,000,000 DED RETENTIONS ACPCAA7272681145 5/5/2015 5/5/2016 S WORKERS COMPENSATION X I PER TUTE OTH- ` AND EMPLOYERS'LIABILITY YIN STA ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N N/A C (Mandatory in NH) - ACPWCD7272681145 5/5/2015 5/5/2016 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Soil Boring, Water Well Drilling and Sampling. Certificate Holders are Additional Insured on CPL & P1 portions of Policy PKC-100865 when required by Written Contract. When agreed upon in written contract the Policy PKC-100865 is endorsed to provide Waiver of Subrogation. , Site: Corner Store / U5-085-14504 CERTIFICATE HOLDER CANCELLATION Dan.Stack@Salina.org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Salina THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Dan Stack ACCORDANCE WITH THE POLICY PROVISIONS. 300 W Ash St Salina, KS 67401 AUTHORIZED REPRESENTATIVE o. j ELIZABETH PETERS/LIZ ' ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(2014011