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Insurance Certificate
I4CORD® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 4,i,-- 9/30/2019 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 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 Melissa Denning-Dick Insurance Planning Inc. IA/CONNO.Ext): (785)625-5605 (A//C No): (765)625-8388 3006 Broadway Avenue aooRless: dennme@insurance-planning.com P. O. BOX 100 INSURER(S) AFFORDING COVERAGE NAIC# Hays KS 67601 INSURER A:National American Insurance Co 23663 INSURED INSURER B: THCM Inc, DBA: TY Contracting INSURER C: 2201 S Lorraine INSURERD: INSURER E: Hutchinson KS 67501 INSURERF: COVERAGES CERTIFICATE NUMBER:19-20 certs 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 LIMITS LTR TYPE OF INSURANCE IN SD WVD POLICY NUMBER IMM/DD/YYYY) IMMIDD/YYYY) X COMMERCIAL GENERAL LIABILITY _EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED — 100,000 A CLAIMS-MADE X OCCUR PREMISES (Ea occurrence) $ 821020115 9/27/2019 9/27/2020 MED EXP(Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO 2,000,000 X POLICY JECT LOC $ OTHER: AUTOMOBILE LIABILITY Ea aMBINED accidentSINGLE LIMIT $ 1,000,000 BODILY INJURY(Per person) $ A ) X ANY AUTO ALL OWNED SCHEDULED 821020115 9/27/2019 9/27/2020 BODILY INJURY(Per accident) $ AUTOS _ AUTOS PROPERTY DAMAGE NON-OWNED (Per accident) $ HIRED AUTOS AUTOS $ Auto Pollution UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A x EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED X RETENTION $ 0 1,1853790115 9/27/2019 9/27/2020 $ WORKERS COMPENSATION X PER OTH- STATUTE ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A A (Mandatory In NH) CW42430115 9/27/2019 9/27/2020 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) 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 Street Salina, KS 67401 AUTHORIZED REPRESENTATIVE M Denning-Dick/DENNME L' ,i L'I'f' I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) A O I® CERTIFICATE OF LIABILITY INSURANCE DATE(MM OD YYY) 9/25/2018 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 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 Nick Flax NAME: Insurance Planning Inc. PHONE EXD. (785)625-5605 I JAIL,NoI: (785)625-8388 3006 Broadway Avenue goonEss:flaxni@insurance-planning.corn P. O. Box 100 INSURER(S)AFFORDING COVERAGE NAM 0 Hays KS 67601 INSURER A:National American Insurance Co I INSURED INSURER 8: THCM Inc, DBA: TY Contracting INSURER C: I 2201 5 Lorraine ENSURER O: I INSURER E: Hutchinson KS 67501 INSURERF: I COVERAGES CERTIFICATE NUMBER:18/19 Certs 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 SBBR POLICY EFF POLICY EXP LTR I TYPE OF INSURANCE I INSD IYNO I POLICY NUMBER I IMMIDDIVYYY)I IMMIDDIYYYY)I LIMITS X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE I $ 1,000,000 A I CLAIMS-MADE X OCCUR PRS aENTED PREMISES((ER occurrence) $ 100,000 I MP21020015 9/27/2018 9/27/2019 MEDEXP(Any one person) $ 5,000 I PERSONALE.ADV INJURY 15 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE I $ 2,000,000 I POLICY PRO I I X JECT LOC PRODUCTS.COMP/OP AGG 15 2,000,000 I OTHER: I S I AUTOMOBILE LIABILITY CEOMBBINEEDt SINGLE LIMIT I s' 1,000,000 A I X I ANY AUTO BODILY INJURY(Per person) I$ ALL OWNED fSCHEDULED 14P21020015 9/27/2018 9/27/2019 BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS I X I gONN-0OslMIE0 PROPERTY DAMAGE UT (Pet accident) 5 I I I I S I I UMBRELLA UAB I X I OCCUR EACH OCCURRENCE $ 5,000,000 A I x I EXCESS LIMB I I CLAIMS-MADE AGGREGATE $ 5,000,000 I I DED I X I RETENTIONS 0 MM953790015 9/27/2018 9/27/2019 $ WORKERS COMPENSATION ' PER 0TH- AND EMPLOYERS'LIABILITY YIN X I STATUTE I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? NIA A (Mandatory In NH) CW42430015 9/27/2018 9/27/2019 E.L.DISEASE-EA EMPLOYEE S 1,000,000 E yes.desalt°under — — DESCPIPTION OF OPERATIONS bet n - . - - - - .- - El DISEASE-POLICY LIMIT-I-1----- 1-,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Salina THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 412 E Ash StreetACCORDANCE WITH THE POLICY PROVISIONS. Salina, KS 67401 AUTHORIZED REPRESENTATIVE / � Nicholas Flax/PILADO / -r�`'e �v ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) ACORD' CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 2128!2018 THIS CE" FICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT •FFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE 'OES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE •LDER IMPORTANT: If , certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS W ED,subject to the terms and conditions of the p• cy,certain policies may require an endorsement A statement on this certificate does not confer rights o the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Jo Shelton Jo Shelton PHONE AX Shelter Insurance (AIC.No.Ext): 620-259-6748 (AIC.No): 620-259-6754 1722 N.Plum-Suite B E-MAIL Hutchinson,KS 67502 ADDRESS: jshelton@shelterinsu - ce.com INSURER(S)AFFORDING C• ERAGE NAM* INSURED NSURER A: Shelter Mutual Insu-nce Company 019748 THCM,INC NSURER B: Riverport Insuran•• dba: Ty Contracting NSURER C: National Union re Insurance Compan 7002351 2021 112 E.41e Ave. NSURER D: Hutchinson,KS 67502 NSURER E: NSURER F: COVERAGES CE- IFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURAN LISTED BELOW HAVE BEEN ISSUED TO TH NSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. _NOTWITHSTANDING.ANY_REOUIREMENT.TERM,OR.CO e ION OF ANY CONTRACT_OR OTHER D• UMENT WITH RESPECT TOWHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED B THE POLICIES DESCRIBED HEREIN I SUBJECT TO ALL THE TERMS_EXCLUSIONS AND CONDITIONS'OF— SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED :Y PAID CLAIMS. INSR ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR • D POLICY N .BER (LDVM1(Y) (MNIDDrrrrn LIMITS GENERAL LIABILITY V EACH OCCURRENCE $ '1000000 DAMAGE TO RENTED PREMISES X COMMERCIAL GENERAL LIABILITY / (Ea accurrence) S 10000 A X CWMS-MADE OCCUR X X •137-5 01-06-2018 01.05-2019 MED EXP(Any onepersonl S 5000 PERSONAL 6ADV INJURY S 1000000 ri GENERAL AGGREGATE S 4000000 GENL AGGREGATE LIMIT APPLIES PER: I PRODUCTS-COMP/OP AGG $ 4000000 POLICY n PROJECT n LOC I $ AUTOMOBILE LIABILITY • COMBINED SINGLE LIMIT ANY AUTO -;l - (Ea accident) $ 1000000 A ALL OWNED SCHEDULED % 161-C-9558137.3 41.2018 10-01-2(118 AUTOS % AUTOS �� BODILY INJURY (Per person) 5 NON-OWNEDell BODILY INJURY(Per accident) S HIRED AUTOS AUTOS N., PROPERTY DAMAGE(Per axidera) _ 5 S C X UMBRELALIAB X I OCCUR •'� X BE030755502 I 03-03.2018 03.oa-201g EACH OCCURRENCE S 1000000 EXCESS UM I CLAIM - ..„► AGGREGATE S 1000000 DED I I RETENTION S - -"r $ WORKERS COMPENSATION WC STATU- 0TH- MD EMPLOYERS'LIABIlITY YINwwNA X TORY UNITS ER B ANY PROPRIETORIPARTNERI`cXECUTIVE 11,2 X KSARP308853 0927(2017 091277201• EL EACH ACCIDENT 5 500000 OFFICERIMEMBER EXCLUDED? EL DISEASE-EA EMPLOYEE S 500000 (Mandatory In NH) II yes,describe under DESCRIPTIONS OF OPERATIONS below E.L.•SEASE-POLICY LIMIT 5 500000 DESCRIPTION OF OPERATIONSIL••CATIONSNEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) I I CERTIFICATE HO •ER CANCELLATION • City o aline SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE > •IRATION 412 •.Ash St. DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVE S. ! S. net.KS 87401 '; AUTHORIZED REPRESENTATIVE ' *3)....),Ek tO___Q$ICCIS\\a t1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo ere registered marks of ACORD