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Insurance Certificate• ACORD CERTIFICATE OF LIABILITY INSURANCE- DATEWDON r) 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 certificateholder in lieu of such endorsement(s). PRODUCER _ • CONTACT Cindy Waters - G M Peters Insurance PHONE 11 N.Water Street INC No.Exti.816-781-4922 I FAX Na):816-781-8050 Liberty MO 64068 E-MAIL ADDRESS: cindywegmpeters.com PRODUCER CUSTOMPRIO e• FTCEQ-1 INSURERS)AFFORDING COVERAGE NAICIt INSURED INSURER A:Employers Mutual Casualty Co. 21415 FTC Equipment, LLC 5238 Winner Rd. INSURER B:EMCASCO 21407 Kansas City MO 64127-1732 INSURER c:Accident Fund National Insurance Company 12305 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:20175372 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. INSRI EFF TYPE OF INSURANCE 'P/SR I5WVDI POLICY NUMBER I(MM/0OYMM /YYY'n I( JDDY EXP rrYYY)I LIMITS LTR A I GENERAL LIABILITY 5E/88592 8/5/2019 8152020 I EACH OCCURRENCE 151.000.000 DAMAGE TO RENTED X I COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) 5500,000 I I I CLAIMS-MADE X OCCUR MED EXP(Any one persan) 15111.000 _ I I - I PERSONAL&ADV INJURY 151.000.000 . I I GENERAL AGGREGATE 52.000.000 GEN_AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/DP AGG 152,000,000 _ I POLICY I I IT/91: 1-1 LOC I I S • B I AUTOMOBILE LIABILITY 5E88E92. - - 8/5/2019 8152020 I COMBINED accident)SINGLE LIMIT 151,000,000 X I ANY AUTO BODILY INJURY(Per person) 5 I I ALL OWNED ALTOS BODILY INJURY(Per accident) 5 SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per acadent) 5 X NON-OOWNED AUTOS I S S A I X /UMBRELLA UAB I tam OCCUR I 5J88692 8152019 8152020 EACH OCCURRENCE 159,000.000 I EXCESS LAB It CLAIMS-MADE AGGREGATE 59,000,000 I I DEDUCTIBLE 1Li— -- IX.IRETENTION S,n mn ___ __ __ _ _ C WORKERS COMPENSATION WCV617135-I 8152019 8152020 I X I TORYT MRc I I0PR I AND EMPLOYERS'LIABILITY ^IY I NI ANY PROPRIETORJPARTNERIEXECUTIVE I l I E.L.EACH ACCIDENT 151.000.000 OFFICER/MEMBER EXCLUDED? N/A JI (Mandatory in NH) I E.L.DISEASE-EA EMPLOYEC $1,000.000 _ It yes, IPTION unoet I E.L.DISEASE-POLICY LIMIT 15 i mn ren DESCRIPTION OF OPERATIONS below A re. I I I5C88692 I 8152019 I 8152020 55400,003 000 Lim? 51,000 Deduct 51,000 Deduct DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,B more space is required) The City of Salina,its agents,representatives,officers.officials,and employees are included as additional insureds(s)on a primary and non-contributory basis including Completed Operations with regard to General Liability Coverage.Waiver of Subrogation is also provided where allowed by law. 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-City County Building 300 E Ash Po 736 AUTHORIZED REPRESENT Salina KS 67402 `/,Q�/('/[/^ I 1 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD A CORE, CERTIFICATE OF LIABILITY INSURANCE 8/8/2(016D ) 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 NAME: Kim Aten G M Peters Insurance PHONE FAX 11 N. Water Street (AIC,No.Ext):816 781-4922 {AIC,No):816-781-8050 E-MAIL Liberty MO 64068 ADDRESS: kima@qmpeters.com PRODUCER CUSTOMER ID#:FTCEQ-1 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA:Missouri Employers Mutual FTC Equipment, LLC INSURERB:Depositors Insurance Company 42587 5238 Winner Rd. Kansas City MO 64127-1732 INSURERC:AMCO Insurance Company 19100 INSURERD:Allied Insurance - - ---- -- . INSURER E: INSURERF: -- " --- - -COVERAGES CERTIFICATE NUMBER:1639428479 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 S W R SUBR POLICY EFF POLICY EXP VD POLICY NUMBER LIMITS (MMIDD/Yl'YY) (MM/DD/YYYY) B GENERAL LIABILITY Y Y ACPGLD07236222070 8/5/2016 8/5/2017 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence)-_ $100,000 _ CLAIMS-MADE X OCCUR MED EXP(Any one person) $5,000 PERSONAL 8 ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 7 POLICY TI I JECOT- n LOC B AUTOMOBILE LIABILITY Y Y ACPBAA7236222070 8/5/2016 8/5/2017 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per accident) X NON-OWNED AUTOS $ $ C x UMBRELLA LIAB X OCCUR ACPCAA7206222070 8/5/2016 8/5/2017 EACH OCCURRENCE $2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $2,000,000 DEDUCTIBLE X I RETENTION $10,000 A WORKERS COMPENSATION 2009200 8/5/2016 8/5/2017 X WCSTATU- 0TH- ' AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N N I A • - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below i E.L.DISEASE-POLICY LIMIT $1,000,000 D Bailee ACPCIM7206222070 8/5/2016 8/5/2017 $300,000 Limit $1,000 Deduct Stock $400,000 Limit $1,000 Deduct DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) The City of Salina, its agents, representatives, officers, officials, and employees are included as additional insureds(s) on a primary and non-contributory basis including Completed Operations with regard to General Liability Coverage. Waiver of Subrogation is also provided where allowed by law. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED City of Salina- City County Building IN ACCORDANCE WITH THE POLICY PROVISIONS. 300 E Ash Po Box 736 Salina KS 67402 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD