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Insurance Certificate To: Public Works of Salina From: AssurancePartners Pages: 1 Sent: 04/03/2018 15:40 A CERTIFICATE OF LIABILITY INSURANCE DATE(MWOw"Y" 04/032018 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 POUCIES 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. U 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 NAME: Assurance Partners PSE (800)563-1871 FAX (785)825-5098 E 201 E Iron Avenue ADDRESS: Istum@yourassurance.com P.O.Box 1213 INSURERS)AFFORDING COVERAGE WIC Safina KS 67402-1213 INSURER A: Nationwide Mutual Insurance Company 23787 INSURER INSURER a: Redwood Fire and Casualty Insurance Company 11673 Salina Iron 8 Metal Company INSURER C: . 312 N 5th St INSURER 0: PO Box 1155 INSURER E: Salina KS 67402.1155 INSURER F: COVERAGES CERTIFICATE NUMBER: 18.19 Ail 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. Pisa ADOL3eOR POLICY EFF POLICY EAP LTR TYPE OF INSURANCE /NSD VNO POLICY NUMBER ,(MWDDFIYYIT (MWDDF/YYY) LIMITS X COMMERCIAL GENERAL LABO.TY EACH OCCURRENCE s 1.000,000 DAMAGE TO RENTED 100.000 CLAIMS-MADE OCCUR PREMISES(Ea occurrence) S MED EXP(Any one person) S 1.000 A - ACP7284880192 04/16/2018 04/162019 PERSONAL&ADYINnmY $ 1.000.000 GEAGGREGATE LIMITAPPIJES PER GENERAL AGGREGATE S 2.000.000 NU X POLICY n Tei F-1 LOC PRODUCTS-COMP/OPAGG $ 2.000.000 OTHER S AUTOMOBILE LLABfJTY COMBINED SINGLE UNIT S 1,000.000 (Ea accident) X ANY AUTO BODILY INJURY(Pm Daum) S A — OWNED — SCHEDULED ACP7284880192 04/16/2018 04/16/2019 BODILY INJURY(Per accident) S AUTOS ONLY AUTOS HIRED X AUTOS NED PROPERTY DAMAGE S X AU OS ONLY !� AUTOS ONLY (Per accident) S X UMBRELLA DAB --X OCCUR EACH OCCURRENCE $ 1.000.000 A EXCESSLAB CLAIMS- ADE ACP7264880192 04/16/2018 04/16/2019 AGGREGATE S 1,000,000 DED X RETENTIONS 0 S WORKERS COMPENSATION >/I PER DTH. LJT AND EMPLOYERS' ABAY YINSTATUTEI ER B MANY PROPRIETORIPARTNERID(ECUTIVE I� HIA SAWC924194 04/16/2018 04/16/2019 E.L.EACH ACCIDENT S 1.000,000 OFFICERE/ABER EXCLUDED? I I (Mandatory in NH) EL DISEASE-EA EMPLOYEE S 1.000,000 Byes.Combe under 1,000.000 DESCRIPTION OF OPERATIONS below EL DISEASE•POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101.Additional Remarta ScMdul,may W attacbd U mere apace h ra9Wnd) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Public Works of Salina ACCORDANCE WITH THE POLICY PROVISIONS. 418 E Ash AUTHORIZED REPRESENTATIVE Salina KS 67401 att.w+ VV ((ff�, 01986.2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD To: Public Works of Salina From: AssurancePartners Pages: 1 Sent: 04/11/2016 14:55 AC�® DATE(MM(DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 4/8/2016 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 Tara Earley Y Assurance Partners PH No Exti (800)563-1871 FAX No)'(785)825-5098 201 E Iron St. MAIL tearl'e @ ourassurance.com ADDRESS: y y P.0. Box 1213 INSURERS)AFFORDING COVERAGE NAIC# Salina KS 67402-1213 tNSURERA:Nationwide Mutual Insurance Co 23787 INSURED INSURER B Bershire Hathaway Homestate Salina Iron & Metal Company INSURER C: 312 N 5th St INSURERD: PO Box 1155 INSURER E: Salina KS 67402-1155 INSURERF: COVERAGES CERTIFICATE NUMBER:16.17 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 (MMIDDIYYYY) (MMIDD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE X OCCUR PREMISES SES Ea occurrence) $ 100,000 ACP7264880192 4/16/2016 4/16/2017 MED EXP(Any one person) $ 1,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: • GENERAL AGGREGATE _ $ 2,000,000 X POLICY JECOT- LOC PRODUCTS-COMP/OP AGG 5 2,000,000 . OTHER: i •$ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) A X ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED ACP72648B0192 4/16/2016 4/16/2017 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS (Per accident) S , S UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 1,000,000 A x EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED I X RETENTIONS 0 ACP7264880192 4/16/2016 4/16/2017 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y I N X STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? NIA B (Mandatory in NH) SAWC710126 4/16/2016 4/16/2017 E.L.DISEASE-EA EMPLOYE S 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 it more space is required) CERTIFICATE HOLDER CANCELLATION (785)309-5713 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Public Works of Salina THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 418 E Ash ACCORDANCE WITH THE POLICY PROVISIONS. Salina, KS 67401 AUTHORIZED REPRESENTATIVE Susan Flaming/SFLAMI "�`� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS02517ni4n11