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Insurance Certificate
�""1 MIDWREC-01 TORIK '4�o�zo CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 12/212020 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 Tori Ketcherside NAME: Charles L.Crane Agency (ac°O,"o,Ext):(636)537-5042 I wc,No):(636)537-5009 400 Chesterfield Ctr,Ste 100 E-MAIL DREss:ToriK@craneagency.com Chesterfield,MO 63017 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Admiral Insurance Company 24856 INSURED INSURER B:Nationwide Mutual Insurance Company 23787 MRC I, LLC dba Midwest Recycling Center INSURER C:Missouri Employers Mutual Ins. 10191 3751 Old Highway M INSURER D:Lloyds Of London-Underwriters at Lloyds Imperial, MO 63052 INSURER E: INSURER F: COVERAGES CERTIFICATE 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTRINSD WVD (MM/DD/YYYY1 (MMIDD/YYYYt A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X X FEIEIL2436703 12/1/2020 12/1/2021 pREMISEnEiaEoccurence) $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY _ $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY j8.: LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: _ $ COMBINED SINGLE LIMIT 1,000,000 B AUTOMOBILE LIABILITY (Ea accident) $ X ANY AUTO X X ACPBA3057491760 12/5/2020 12/5/2021 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ $ A UMBRELLA LIAB X OCCUR EACH OCCURRENCE _ $ 2,000,000 X EXCESS LIAB CLAIMS-MADE 'FEIEXS2688601 12/1/2020 12/1/2021 AGGREGATE $ DED X I RETENTION$ 0 _ $ C WORKERS COMPENSATION X I STATUTE 1 1 OOTH AND EMPLOYERS'LIABILITY YIN MEM 201465706 12/1/2020 12/1/2021 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER NHR EXCLUDED? N/A 1,000,000 E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below _ E.L.DISEASE-POLICY LIMIT $ A Environmental/CPL x x FEIEIL2436703 12/1/2020 12/1/2021 Pollution 2,000,000 D Cyber Liability MPL208810820 10/20/2020 10/20/2021 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City of Salina,its agents,representatives,officers,officials,and employees are named as additional insureds under the general liability, auto liability, and pollution liability as required by written contract. Waiver of subrogation under the general liability, auto liability,and pollution liability as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Salina THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. P.O.Box 736 Salina,KS 67402-0736 AUTHORIZED REPRESENTATIVE I Joel /' ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ,/. MIDWREC-01 TORIK 4CORO' CERTIFICATE OF LIABILITY INSURANCE DATE(MI1'YY) h,..---- 12/2312016 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. 7 IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. H 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 Charles L.Crane Agency Co. Charles L.Crane Agency laO,N co,EA:(636)537-5000 FAX No(636) 537-5009 400 Chesterfield Ctr,Ste 320 I ADDRESS; Chesterfield,MO 63017 INSURER( AFFORDING COVERAGE I NAIC0 INSURER A:Mt. Hawley Insurance Company 137974 INSURED INSURER a:AMCO Insurance Company 19100 MRC 1,LLC dba Midwest Recycling Center INSURER C:National Union Fire Ins of PA 19445 3751 Old Highway M INSURER D:Missouri Employers Mutual Ins. 10191 Imperial,MO 63052 INSURER E:Crum&Forster Specialty 144520 INSURER F:Lloyds Of London -Underwriters at Lloyds I COVERAGES CERTIFICATE 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. WSR IADDLISUBR POLICY EFF POLICY EXP r LTA TYPE OF INSURANCE INSDI WVD POLICY NUMBER LIMITS A X COMMERCIAL GENERAL LIABILITY (MMmDrrrYr, (MM/ODIYYYIT 1,000,000 EACH OCCURRENCE IS CLAIMS-MADE X OCCUR DAMAGE TO RENTEDI 50,000 IX X MGL0184539 1210$12016 1210512017 pREMis€S(Ea we) MED EXP(Any one person)—II$ 1,000 PERSONAL&ADV INJURYFS S 1.000'000 GEN.AGGREGATE Ter- APPLIES PER GENERAL AGGREGATE I S 2,000,000 POLICY X JECT LOC PRODUCTS-COMP/OPAGG I S 2,000,000 OTHER I$ B AUTOMOBILEIIABILITY I COMBINED SINGLE LIMIT I$ 1,000,000 Ea zaAtleDU X ANY AUTO X X ACPBAA3017491760 12/0512016 1210512017 BODILY INJURY(Per person) I S OWNED SCHEDULED AUTOS ONLY AUTOS I BODILY INJURY(Per accident)!HIRED NOµpWNED PROPERTY DAMAGE I AUTOS ONLY AUTOS ONLY (Per amdent) I S C I UMBRELLA UAB I X OCCUR EACH OCCURRENCE I$ 2,000,000 X EXCESSUAB I CLAIMS-MADE 13E014706923 12/05/2016 12/05/2017 AGGREGATE I S 2,000,000 DED I X I RETENTIONS 0 I$ D WORKERS COMPENSATION I X I PER I LITH- I AND EMPLOYERS'LIABILrTY S ANY PROPRIETOR/PARTNER/EXECUTIVE YIN X MEM201465702 1210112016 12101120171 I S 1,000,000 OFFICE EMB R EXCLUDED? N I A EL.EACH ACCIDENT (Mandalo.y N NX) E.L.DISEASE-EA EMPLOYEE S 1'000'000 N edescribe ender DESCs,RIPTION OF OPERATIONS below E L DISEASE-POLICY UNIT I$ 1,000,000 E Contractor Pollution 1PKC104688 12/05/2016 12/05/2017 2,000,000 F Cyber Liability UCS271547716 10/20/2016 1012012017 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Add/Donal Remarks Schedule,may be attached N more space is required) The City of Salina,Its agents,representatives,officers,officials,and employees are named as additional Insureds under the general liability and auto liability as required by written contract. Waiver of subrogation under the general liability, auto liability,and pollution liability as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ci of Salina,KS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Chris Slubowski 412 E.Ash Street Salina,KS 67401 AUTHORIZED REPRESENTATIVE I ! A / Zit– ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Nicholson,Teresa • From: Schuessler, Nancy Sent: Tuesday, December 27, 2016 9:08 AM To: Slubowski, Chris Cc: Nicholson, Teresa Subject: RE: FW: Midwest Recycling Center(MRC) Ins. Cert. Follow Up Flag: Follow up Flag Status: Flagged Chris, The Certificate looks perfect. Thanks! Nancy Schuessler Risk Management Specialist City of Salina 300 W. Ash, Room 202 P.O. Box 736 Salina, KS 6'?402-0736 Phone: 785.309.5705 Fax: 785.309.5711 TDD: 785.309.5747 E-mail: nancv.schuessleresalina.orq Website: www.salina-ks.gov "The information transmitted is intended only for the person or entity to which it is addressed and may contain confidential and/or privileged material.Any review, retransmission,dissemination or other use of,or taking of any action in reliance upon,this information by persons or entities other than the intended recipient is prohibited.If you received this in error,please contact the sender and delete the material from all computers." From: Slubowski, Chris Sent: Tuesday, December 27, 2016 7:38 AM To: Schuessler, Nancy Cc: Nicholson, Teresa Subject: FW: FW: Midwest Recycling Center(MRC) Ins. Cert. Hi Nancy, I've attached the amended insurance document for our e-waste contractor. Please review and let me know if it now fulfills our requirements. Thanks, Chris Slubowski Household Hazardous Waste Coordinator Department of Public Works, City of Salina, KS Phone (785)826-6638 Fax(785)826-7373 • chris.slubowski@salina.orq 1 From: Ryan Hall [mailto:ryanhall@midwrc.net] Sent: Tuesday, December 27, 2016 7:29 AM To: Slubowski, Chris Subject: Re: FW: Midwest Recycling Center(MRC) Ins. Cert. Chris, Please see the attached document. Thanks, Ryan On Wed, Dec 21, 2016 at 10:39 AM, Slubowski, Chris <chris.slubowski@salina.org> wrote: Hi Ryan, Please note the concerns listed below concerning the Insurance certificate you sent me. Please make the corrections needed and get that back to me as soon as you can. Have you received the contract copies? Wishing you a very Merry Christmas! • Chris Slubowski Household Hazardous Waste Coordinator Department of Public Works, City of Salina, KS Phone f785)826-6638 Fax f 785)826-7373 chris.slubowski@salina.orq • From: Schuessler, Nancy Sent: Tuesday, December 13, 2016 2:13 PM To: Nicholson,Teresa Cc: Slubowski, Chris Subject: RE: Midwest Recycling Center(MRC) Ins. Cert. Teresa, I noticed the Certificate doesn't list the City of Salina as an additional insured under their GL and Auto Liability policies. In addition,there should be reference to a waiver of subrogation under GL, Auto and work comp. Nancy Schuessler • Risk Management Specialist City of Salina 300 W. Ash, Room 202 P.O. Box 736 Salina, KS 67402-0736 Phone: 785.309.5705 Fax: 785.309.5711 TDD: 785.309.5747 E-mail: nancy.schuessler@salina.org Website: www.salina-ks.gov "The information transmitted is intended only for the person or entity to which it is addressed and may contain confidential and/or privileged material.Any review, retransmission,dissemination or other use of,or taking of any action in reliance upon,this information by persons or entities other than the intended recipient is prohibited.If you received this in error,please contact the sender and delete the material from all computers." 2 From: Nicholson, Teresa Sent: Tuesday, December 13, 2016 1:57 PM To: Schuessler, Nancy Cc: Slubowski, Chris Subject: Midwest Recycling Center (MRC) Ins. Cert. « File: MRC Insurance Certificate.pdf» Nancy, Attached is a copy of MRC's updated insurance for the 2017 E-waste Event. Please let me know if you need anything further. Thanks, rot.. Teresa Nicholson Admin.Assistant 11 City of Salina Public Works Department 1785)309-5750 or 1785)833-8201 Ryan D. Hall Logistics Supervisor MRC Recycling 3751 Old Highway M Imperial MO 63052 314-623-8979 3