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Insurance Certificate A�D CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYVYY) 12/17/2020 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 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 Doris Pilatus NAME: Insurance Planning Inc. IA/CNo,ExtI: (785)625-5605 FAX No): "")625-"" 3006 Broadway Avenue a-DRESS:pilado@insurance-planning.com P. 0. Box 100 INSURER(S) AFFORDING COVERAGE NAIC f1 Hays KS 67601 INSURER A:Acadia Insurance Company 31325 INSURED INSURER B: Nex-Tech Wireless LLC, INSURERC: 3001 New Way INSURERD: INSURER E: Hays KS 67601 INSURERF: COVERAGES CERTIFICATE NUMBER:2021/2022 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP WLIMITS LTR INSD VD POLICY NUMBER IM IMMIDD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTE A CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) 600,000 RIIP272175134 1/1/2021 1/1/2022 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000. X POLICY PRO- JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 JEa accident) X ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED _ AUTOS _ AUTOS RIIP272175139 1/1/2021 1/1/2022 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS (Per accident) X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 10,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE ,$ 10,000,000 DED X RETENTION$ 0 RIIP272175134 1/1/2021 1/1/2022 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE NO COVERAGE AFFORDED E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E .DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: Bicentennial Tower Salina KS 30 day notice is no longer applicable in KS. Certificate holder is an additional insured in regards to the Gen Liab & Auto Liability if required by written contract or agreement. . Waiver of Subrogation applies to the General Liability, & Auto Coverage. Gen Liab is Primary & Non Contributory. 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 ACCORDANCE WITH THE POLICY PROVISIONS. City Clerk PO Box 736 Salina, KS 67402-0736 AUTHORIZED REPRESENTATIVE Doris Pilatus/PILADO / Yd /7jQ ,g ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) TE A�® CERTIFICATE OF LIABILITY INSURANCE DA 6/1 o1D8 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 Telcom Insurance Services Corp. CONTACT 6301 Ivy Lane, Suite 506 PHONE FTelcom Insurance Services Corp.AX Greenbelt, MD 20770 (A/C No.EMI: E-MAIL800.222.4664 (AM.No): 301.474.6196 ADDRESS: INSURER(S)AFFORDING COVERAGE I NATO/ WWW.TelcominsGrp.com INSURER A: Rural Trust Insurance Company, Inc. 11134 INSURED INSURER B: Rural Telephone Service Co., Inc. Nex-Tech Communications, LLC INSURER C: 145 North Main INSURERD: Lenora KS 67645 INSURER E: • INSURER F: COVERAGES CERTIFICATE NUMBER: 42297736 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. INLTR I TYPE OF INSURANCE INWDADDLISNM I POUCY NUMBER I(MMM/DDDYIYYYY)EFF I(MWDDYIYYYY)EXP I LIMITS A ./ I COMMERCIAL GENERAL LIABILITY ✓ RTIC-00101P-04 6/1/2018 6/1/2019 EACH OCCURRENCED131,000,000 CLAIMS-MADE ✓ OCCUR PREMISES EaGE TOENTED ocwrence) S 1,000,000 MED EXP(Any one person) S 10,000 PERSONAL a ADV INJURY $1,000,000 GENL AGGREGATE LIMIT APPLIES PER: h GENERAL AGGREGATE 52,000.000 POLICY EPR - CT LOC PRODUCTS-COMP/OP AGG 52,000,000 OTHER: S A AUTOMOBILELIABILITY RTIC-00101P-04 6/1/2018 6/1/2019 aEaMBINEDOSINGLE LIMIT 51,000,000 ✓ ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED BODILY INJURY(Per accident) S _ AUTOS ONLY AUTOS ✓ HIRED NON-OWNED AUTOS ONLY AUTOS ONLY (Per aac�ent)PY S S A j UMBRELLA UAB I OCCUR RTIC-00101P-04 6/1/2018 6/1/2019 EACH OCCURRENCE 1310,000,000 EXCESS UAB CLAIMS-MADE AGGREGATE S 10,000,000 — -- _--I DED I ✓I RETENnON510,000 I - I - - -._ S _- — A WORKERS COMPENSATION RTIC-00157-03 10/1/2017 10/1/2018 ✓ I PEAT11TE I I ER AND EMPLOYERS'LIABILITY YIN NIYPROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $1,000,000 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 1 000 000 H yes.desuibe,rider DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1.000.000 A REAL AND BUSINESS PERSONAL RTIC-00101P-04 6/1/2018 6/1/2019 Blanket Limit$126,820,547 PROPERTY DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) The City of Salina is listed as an Additional Insured as required by written contract. CERTIFICATE HOLDER CANCELLATION The Ci of Salina SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CityTHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Risk Management Specialist ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 736 Salina KS 67402-0736 AUTHORIZED REPRESENTATIVE `Qai14. 5 &kelt— ' Peter J.Elliott _ ---- --- – •©1986-2015-ACORDCORPORATION.rAlfrights-reserved.— ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 42297136 12012-19 Master Certificate 1 Sally 3 Martin 1 6/1/2018 11:01:18 AX (EDT) 1 Page 1 of 1 9 Berkley Net Kansas Workers' Compensation Insurance Plan Riverport Insurance Co I NCCI Carrier Code 27995 I a Berkley Company Administered by BerkleyNet Assigned Risk WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT Policy Number: KSARP308556 Tax ID#: 20-1189456 NEX-TECH WIRELESS LLC Policy Period: From: 09/15/2018 3001 NEW WAY To: 09/15/2019 HAYS, KS 67601-3262 Endorsement Date 09/15/2018 Date of Mailing: 09/24/2018 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Waiver Holder Name DBA City of Salina Comments All other terms and conditions of this policy remain unchanged. Agency Name and Address Insurance Planning Inc PO Box 100 Hays, KS 67601-0100 WC 00 03 13 P.O.Box 591431 Minneapolis,Minnesota 55459-01431 Toll Free(888)548-7431 I Fax(866)215-8118 www.berdeyassignedrisk.com I assignedrisk@berkleynet.com