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Insurance Certificate DATE(MMIDD/YYYY) A`O CERTIFICATE OF LIABILITY INSURANCE 02/26/2021 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). CONTACT Erin Burch PRODUCER NAME: Assurance Partners,LLC PHONE (800)563-1871 FAX No): (785)825-5098 (A/C,No,Ext): E-MAIL eburch@yourassurance.com 201 EIronAvenue ADDRESS: P.O.Box 1213 INSURER(S)AFFORDING COVERAGE NAIC# Salina KS 67402-1213Old Republic Insurance Company 24147 INSURER A: INSUREDINSURER B: Travelers Property Casualty Company of America 25674 Hall Brothers,Inc. INSURER C: Continental Casualty Company 20443 1196 Pony Express Hwy INSURER D: PO Box 166 INSURER E: Marysville KS 66508-0166 INSURER F: COVERAGES CERTIFICATE NUMBER: 21.22 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 ADDL UBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITYEACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 500,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 10,000 A Y Y MWZY312229 03/01/2021 03/01/20221,000,000 PERSONAL INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: 2,000,000 PRO- PRODUCTS-COMP/OPAGG $ POLICY X JECT LOC $ OTHER: COMBINED SINGLE LIMIT $ 1,000,000 AUTOMOBILE LIABILITY (Ea accident) _ X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED Y Y MWTB312228 03/01/2021 03/01/2022 BODILY INJURY(Per accident) $ AUTOS ONLY _ AUTOS PROPERTY DAMAGE $ X HIRED X AUUTOS ONLYY (Per accident) AUTOS ONLY $ X UMBRELLA LIAB X OCCUR _EACH OCCURRENCE $ 4,000,000 B EXCESS LIABZUP14P61900 03/01/2021 03/01/2022 AGGREGATE $ 4,000, �/ 000 CLAIMS-MADE DED X RETENTION $ 10,000 _ $ WORKERS COMPENSATION X STATUTE EORH AND EMPLOYERS'LIABILITY YIN1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE MWC312230 03/01/2021 03/01/2022 E.L.EACH ACCIDENT $ A NIA Y OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 1,000,000 (Mandatory In NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below Limit $750,000 Rented/Leased Equipment C 5090930309 03/01/2021 03/01/2022 Deductible $5,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Re:Project No.70006 2017 Mastic Surface Treatment 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 300 WAsh,Room 202 AUTHORIZED REPRESENTATIVE Salina KS 67401 Y I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 02/26/2020 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). CONTACT PRODUCER Lindsey Sturn NAME: FAX PHONE Assurance Partners(800) 563-1871(785) 825-5098 (A/C, No): (A/C, No, Ext): E-MAIL 201 E Iron Avenue lsturn@yourassurance.com ADDRESS: P.O. Box 1213 INSURER(S) AFFORDING COVERAGENAIC # Salina KS67402-1213 Old Republic Insurance Company24147 INSURER A : INSURED Travelers Property Casualty Company of America25674 INSURER B : Hall Brothers, Inc.Continental Casualty Company20443 INSURER C : 1196 Pony Express Hwy INSURER D : PO Box 166 INSURER E : Marysville KS66508-0166 INSURER F : 20.21 All Lines 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. ADDLSUBR INSR POLICY EFFPOLICY EXP TYPE OF INSURANCE LIMITS POLICY NUMBER LTR(MM/DD/YYYY)(MM/DD/YYYY) INSDWVD COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE$ DAMAGE TO RENTED 500,000 CLAIMS-MADEOCCUR$ PREMISES (Ea occurrence) 10,000 MED EXP (Any one person)$ A Y Y MWZY 312229 03/01/202003/01/2021 1,000,000 PERSONAL & ADV INJURY$ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- 2,000,000 POLICY LOC PRODUCTS - COMP/OP AGG$ JECT $ OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY 1,000,000 $ (Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNED SCHEDULED A Y Y MWTB 312228 03/01/202003/01/2021 BODILY INJURY (Per accident)$ AUTOS ONLYAUTOS HIRED NON-OWNED PROPERTY DAMAGE $ (Per accident) AUTOS ONLYAUTOS ONLY $ UMBRELLA LIAB 2,000,000 OCCUR EACH OCCURRENCE$ B EXCESS LIAB ZUP14P61900 03/01/202003/01/2021 2,000,000 CLAIMS-MADE AGGREGATE$ 10,000 DED RETENTION$$ PER OTH- WORKERS COMPENSATION STATUTEER AND EMPLOYERS' LIABILITY Y / N 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT$ A N / A Y MWC312230 03/01/202003/01/2021 OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT$ Limit$750,000 Rented/Leased Equipment C 5090930309 03/01/202003/01/2021 Deductible$5,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Project No. 70006 2017 Mastic Surface Treatment 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 300 W Ash, Room 202 AUTHORIZED REPRESENTATIVE Salina KS67401 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD A�® CERTIFICATE OF LIABILITY INSURANCE DATE E(MMIDD 9 n 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 Lindsey Stum NAME: Assurance Partners PHONE (800)563-1871 I FAX (785)825-5098 IANC.No.Eat): (A/C,No): 201 E Iron AvenueADDRESS: Istum©yourassurance.Lom P.O.Box 1213 INSURERS)AFFORDING COVERAGE NAIL e Salina KS 67402-1213 INSURER A: Old Republic Insurance Company 24147 INSURED INSURER B: Travelers Property Casualty Company ofAmerica 25674 Hall Brothers,Inc. INSURER C: Continental Casualty Company 20443 1196 Pony Express Hay INSURER D: PO Box 166 INSURER E: Marysville KS 66508-0166 INSURER F: COVERAGES CERTIFICATE NUMBER: 19.20 A11 Lines REVISION NUMBER: THIS 15 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 ADDLSUBH POLICY EFF POICYEXP LTR TYPE OF INSURANCE ,INSD WWI POLICY NUMBER (MMNDDIWYY) (MMJDDYYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY 1,000,000 • EACH OCCURRENCE 5 OAMAGeSO Ref(,ED 500,000 CIAIMS-MADE X OCCUR PREMISES(Ea occvrenre) 5 MED EXP(Any one person) 3 10,000 A Y Y MWZY 312229 03/01/2019 03/01/2020 PERSONAL SADV INJURY s 1,000,000 2.000,000 GENL AGGREGATE LIMITAPPLIES PER: _GENERAL AGGREGATE 3 1 POLICY nmri 2000000 JECT LOC PRODUCTS-fAMPIOP AGG 5 , , OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5 1,000,000 JEa accident; — X ANY AUTO BODILY INJURY(Per Person) $ A OWNED [SCHEDULED Y Y MWB 312228 03/01/2019 03/01/2020 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS _ HIRED NON-O'AMED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY (Peramdenq 5 5 • X UMBRELLA UAB X OCCUR EACH OCCURRENCE S 4,000,000 B EXCESS DAB CLAIMS-MADE i ZUP14P61900 03/01/2019 03/01/2020 AGGREGATE $ 4.000,000 DED X RETENTION S 10,000 3 WORKERS COMPENSATION X STI PER OTH- AND EMPLOYERS'LIABILITY YIN ER ER A ANY PROPRIETOR/PARTNERJEXECUTNE NIA Y MWC312230 03/01/2019 03/01/2020 E.L EACH ACCIDENT 5 1.000.000 OFFICERIMEMBER EXCLUDED9 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE 5 1.000,000 If yes.describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT 5 Limit 5750,000 Rented/Leased Equipment C 5090930309 03/01/2019 03/01/2020 Deductible 55,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space Is required) Re:Project No.70006 2017 Mastic Surface Treatment 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.Room 202 AUTHORIZED REPRESENTATIVE {1 Salina KS 67401 Y, (-A- C_1f- I (I ©1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(IAMDDY YY 1/41.....------- 03/09/2018 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 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 Lindsey Stum NAME: Assurance Partners PHONE (800)563-1871 FAX 825-5098 (AIC,No,Ea* (AIC,No): ) 201 E Iron Avenue E-MAILDRSS- Isturn©yourassurance.com P.O.Box 1213 INSURER(S)AFFORDING COVERAGE NAIC I Salina KS 67402-1213 INSURER A: Old Republic Insurance Company 24147 INSURED Travelers ProperlyCasualty INSURER B: Co of America 25674 Hall Brothers,Inc. INSURER C: Continental Casualty 20443 1196 Pony Express Hwy INSURER D: Box 166 INSURER E: Marysville KS 66508-0166 INSURER F: COVERAGES CERTIFICATE NUMBER: 18.19 AII'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. INSRADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IINSD WVD POLICY NUMBER (MMIDDIYYYY) (MMNDIYYYY) OMITS X COMMERCIAL GENERALLIABIUTY 1,000,000 EACH OCCURRENCE 5 CLAMS-MADE [1 PREMISES(OCCUR ESf ReNILD 500.000 REMIEa=ems) 5 MED EXP(AM one Person) ' 10,000 A Y Y MWZY 312229 03/01/2018 03/01/2019 PERSONAL 8.ADV INJURY $ 1.000.000 GEMAGGREGATE LIMITAPPUES PER: GENERAL AGGREGATE $ 2.000.000 I POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 — I OTHER: $ . AUTOMOBILE LIABILITYCOMBINED SINGLE OMIT s 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ A OWNED —SCHEDULED Y Y MWTB 312228 03/01/2018 03/01/2019 BODILY INJURY(Per accident) $ AUTOS ONLY _ AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY - (Per accideml $ X UMBRELLA UAB X OCCUR EACH OCCURRENCE 5 4,000,000 B . EXCESS UAB CLAIMS-MADEZUP14P6190017NF 03/01/2018 03/01/2019 AGGREGATE $ 4,000,000 DED X RETENTION$ 10,000 - 5 WORKERS COMPENSATION PER OTH- ANDEMPLOYERS'WBILITY X STATUTE ER Y A EXCLUDED? ANY PROPRIETOR RJEXECUTIVE (� NIA Y MWC312230 03/01/2018 03/01/2019 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER I I (Mandatory in NH) E.L.DI CFacE-EA EMPLOYEE $ 1,000,000 If yes.desmhe ender 1,000,000 - DESCRIPTION OFOPERATIONS bebw E.L.DISEASE-POLICY LIMIT s Rented/Leased Equipment Limit 5750,000 C 5090930309 03/01/2018 03/01/2019 Deductible $5,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached II more space Is required) Re:Project No.70006 2017 Mastic Surface Treatment This is an amended certificate and supercedes any previously issued certificate. • 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 WAsh,Room 202 AUTHORIZED REPRESENTATIVE Salina KS 67401 �-vI:140ki''.. I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD -