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Insurance Certificate F`o® CERTIFICATE OF LIABILITY INSURANCE DATENIN/20IDIBWWY 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. x 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 2 certificate does not confer rights to the certificate holder in lieu of such endorsement(s). c CONTACT 0 PRODUCER NAME: — AOn Risk Services Central, Inc. PHONE (g66) 283-7122 FAX (800) 363-0105 C Chicago IL office IA/C.No.EXLI: (Arc.No.): 0 200 East Randolph E-MAIL 1 Chicago IL 60601 USA ADDRESS: _ INSURER(S)AFFORDING COVERAGE MAIC# INSURED INSURER A: old Republic Insurance Company 24147 PCL Construction. Inc. INSURER8: Indian Harbor Insurance Company 36940 1711 W. Greentree Drive Suite 201 INSURER C: Tempe AZ 85284 USA • INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570072022189 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. Limits shown are as requested INSR ADDII��SUBR POLICYEFF POOJCY EXP LTR TYPE OF INSURANCE I INSDI VND POLICY NUMBER I MMIDDIfYY1'� IMMID I LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY313941 0//01/2018 07/01/ EACHOCCURRENCE $10,000,000 CLAIMS-MADE n OCCUR DAMAGETORENiED $5,000,000 PREMISES(Ea oavnence% — MED EXP(Any one person) $10,000 PERSONALS ADV INJURY $10,000,000 m GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 510,000,000 N 1 POLICY I 1PEo- n LOC PRODUCTS-COMP/OP AGG $10,000,000 N OTHER: o A AUTOMOBILE LIABILITY MWTB 313942 07/01/2018 07/01/2019 COMBWEDSWGLELOM $2,000,000 m /Ea accident BODILY INJURY(Per person) 0 X- ANY AUK: __ z — OWNED 1-1SCHEDULEDBODILY INJURY(Per acvdent) 0 AUTOS ONLY IlllI III AUTOS u X HIREDAUTos NON-OWNED PROPERTY DAMAGE —.ONLY AUTOS ONLY (Per accident) r_ C CPX742008705 07/01/2018 07/01/2019U e UMBRELLA UAB X OCCUR EACH OCCURRENCE 520,000,000 X- EXCESS UAB CLAIMS-MADE AGGREGATE 520,000,000 DED (RETENTION A WORKERS COMPENSATION AND MWC31394000 07/01/2018 07/01/2019 X ISPERTUTE I IOTH- EMPLOYERS'LIABRITY TAER Y PROPRIETOR/PARTNER/EXECUTIVE YIN ANEL.EACHACCIOENT 52,000,000 OFFICERMEMBER EXCLUDED/ n NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE 52,000,000 I yea.dePTION scribe under 'DESCRIOF OPERATIONS Delve: - EL DISEASE-POLICY LIMIT 52,000,000— B Env contr Prof CE0744694802 /01/ Per Claim/Aggr 55,000,000 520,000,000 CPX742008705 I 07I Per Claim/Aggr SIR applies per policy terFls & condi2018 ljions07/01/2019 SIR 525,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101.Additional Remarks Schedule,may be attached If more space is required) S� RE: Evidence of Insurance/RFQ for Salina South well Field and Water Treatment Plant Improvement Project. 0 t— al CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE S--. EXPIRATION EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE -4_� POLICY PROVISIONS. city of Salina, Kansas AUTHORIZED REPRESENTATIVE CO-: Attn: Martha Tasker r_. 300 West Ashicy � � rhr Salina, KS 67401 USAtiZa l/7LO�G,YcI� azz ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET NOTIFICATION TO OTHERS CANCELLATION This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM SCHEDULE Number of Days Notice: 120 Person or Organization: A. If we cancel this Policy by written notice to the first Named Insured for any reason other than nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation: 1. To the name and address corresponding to each Person or Organization shown in the above Schedule, and 2. At least 10 days prior to the effective date of the cancellation, as advised in our notice to the first Named Insured, or the longer Number of Days Notice if indicated in the above Schedule. B. If we cancel this Policy by written notice to the first Named Insured for nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each Person or Organization shown in the above Schedule at least 10 days prior to the effective date of such cancellation. C. If notice as described in paragraphs A. or B. of this endorsement is mailed, proof of mailing will be sufficient proof of such notice. CA 768 001 0718 Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET NOTIFICATION TO OTHERS CANCELLATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART/FORM SCHEDULE Number of Days Notice: 120 Person or Organization: A. If we cancel this Policy by written notice to the first Named Insured for any reason other than nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation: 1. To the name and address corresponding to each Person or Organization shown in the above Schedule, and 2. At least 10 days prior to the effective date of the cancellation, as advised in our notice to the first Named Insured, or the longer Number of Days Notice if indicated in the above Schedule. B. If we cancel this Policy by written notice to the first Named Insured for nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each Person or Organization shown in the above Schedule at least 10 days prior to the effective date of such cancellation. C. If notice as described in paragraphs A. or B. of this endorsement is mailed, proof of mailing will be sufficient proof of such notice. GL 768 003 0718 Page 1 of 1 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY BLANKET NOTIFICATION TO OTHERS CANCELLATION THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY SCHEDULE NUMBER OF DAYS NOTICE : 120 PERSON OR ORGANIZATION: ALL CERTIFICATE HOLDERS WHERE NOTICE OF CANCELLATION IS REQUIRED BY' WRITTEN'^ • •• CONTRACT OR AGREEMENT WITH THE NAMED INSURED SUBJECT TO THE FOLLOWING PROCEDURES : WE WILL MAIL OR DELIVER NOTIFICATION THAT SUCH COVERAGE PART HAS BEEN CANCELLED TO EACH PERSON OR ORGANIZATION SHOWN IN AN ACCURATE SCHEDULE PROVIDED TO US BY THE FIRST NAMED INSURED AT INCEPTION OF THE POLICY OR AS PERIODICALLY UPDATED. NOTICE WILL BE MAILED OR DELIVERED AS SOON AS PRACTICABLE AFTER AN ACCURATE LIST OF NAMES AND ADDRESSES IS PROVIDED TO US BY THE FIRST NAMED INSURED IN RESPONSE TO OUR REQUEST. A. IF WE CANCEL THIS POLICY BY WRITTEN NOTICE TO THE FIRST NAMED INSURED FOR ANY REASON OTHER THAN NONPAYMENT OF PREMIUM, WE WILL MAIL OR DELIVER A COPY OF SUCH WRITTEN NOTICE OF CANCELLATION: 1 . TO THE NAMED AND ADDRESS CORRESPONDING TO EACH PERSON OR ORGANIZATION SHOWN IN THE ABOVE SCHEDULE AND 2 . AT LEAST 10 DAYS PRIOR TO THE EFFECTIVE DATE OF THE CANCELLATION, AS ADVISED IN OUR NOTICE TO THE FIRST NAMED INSURED, OR THE LONGER NUMBER OF DAYS NOTICE IF INDICATED IN THE ABOVE SCHEDULE. FORM A Page 1 IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY B. IF WE CANCEL THIS POLICY BY WRITTEN NOTICE TO THE FIRST NAMED INSURED FOR NONPAYMENT OF PREMIUM, WE WILL MAIL OR DELIVER A COPY OF SUCH WRITTEN NOTICE OF CANCELLATION TO THE NAME AND ADDRESS CORRESPONDING TO EACH PERSON OR ORGANIZATION SHOWN IN THE ABOVE SCHEDULE AT LEAST 10 DAYS PRIOR TO THE EFFECTIVE DATE OF SUCH CANCELLATION. C. IF NOTICE AS DESCRIBED IN PARAGRAPHS A. OR B. OF THIS ENDORSEMENT IS MAILED, PROOF OF MAILING WILL BE SUFFICIENT PROOF OF--SUCH-NOTICE-.--•- - -- ------ - - ----- , - - -- FORM -- ------ - - - ----FORM A Page 2 This page intentionally left blank.