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Insurance Certificate JOHNFAR-01 TBURCHAM '4�� CERTIFICATE OF LIABILITY INSURANCE DATEEE 7116//221M11d01199 0 7 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(les)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 NAME Midwest Regional Agency PHONE FAX 8251 Northwoods Dr.Suite B IEAIc,No,Er):(402)483-1045 �(AIC,Nor(402)483-0648 Lincoln,NE 68505 ADDRESS: INSURERISI AFFORDING COVERAGE NAICC INSURER A:United Fire&Casualty Co 13021 INSURED INSURER B:Berkley Assigned Risk Services Johnson Farms,Inc. INSURER C: 588 N.Niles Road INSURER D: Salina,KS 67401 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. WSR TYPE OF INSURANCE ADOL SUER POUCY NUMBER POLICY EFF POLICY EXP LIMITS I TR MED WVD IMMJDD//YY1') IMM/DDIWYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CWMS-I ADE ri OCCUR 60414141 7/13/2019 7/13/2020 PREM SESOEREMo Emnencel 5 100,000 MED EXP(Any one person) 5 5600 PERSONAL B ADV INJURY $ 1x000'000 GENL AGGREGATE LIMIT APPUES PER: GENERAL AGGREGATE 5 2,000,000 Ta2,000,000 I X POLICY J LOC PRODUCTS AGG $ OTHER: $ COMBINEDadeentSINGLE WAIT 1,BBD,DDB A AUTOMOBILE LJABIUTY (Fe — ANY AUTO 60414141 7/13/2019 7/13/2020 BODILY INJURY(Per person) $ OWNED SCHEDULED _ AUTOS ONLY X AAUUTOSSWN p BODILY INJURY(Per arndent) $ _ AI/TOS ONLY _ atom (Peri amdgAMAGE $ A X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS UAB CLAIMS-MADE 60414141 7/13/2019 7/13/2020 AGGREGATE 5 DED X RETENTIONS 10,000 S 1,000,000 B WORKERS COMPENSATIONPER OTH- ANDEMPLOYERS'MERIT( YINX STATUTE ER ANY PROPRIETOR/PARTNERJEXECUTIVE KSARP307864 5/11/2019 SH 112020 E.L.EACH ACCIDENT 5 100,000 aougt IMEMgER EXCLUDED? N I A ,Mandatory to NH) E.L.DISEASE-EA EMPLOYEES 100,000 If yes.describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY OMIT S A General Liability 60414141 7/1312019 7/13/2020 Damage on Rented Equ 100,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,AddaUonal Remarks Schedule,may be attached it more space Is required) 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. Department of Finance&Administration Office of City Clerk 300 West Ash Street Suite 206 AUTHORIZED REPRESENTATIVE Salina,KS 67402 //' r9— ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD /-ml1 JOHNFAR-01 TBURCHAM '4� CERTIFICATE OF LIABILITY INSURANCE Cr D07/11/2 Y8 on1v2o1a 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 NAONMTACT Midwest Regional Agency PHONE FAX 201 South 84th Street (AIC,No,Ertl:(402)483-1045 . I(AID,N0):(402)483-0648 Lincoln,NE 68510 ADDR ADOR INSURERIS)AFFORDING COVERAGE NAIC e INSURER A:United Fire&Casualty Co 13021 INSURED INSURERB:Berkley Assigned Risk Services Johnson Farms,Inc. INSURER C: 588 N.Niles Road INSURER D: Salina,KS 67401 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 ADDLSUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD YND IMM/DD/YYYYI IMWDDIYYYYI A X COMMERCIAL GENERAL UABILITY 1,000,000 EACH OCCURRENCE S CLAIMS-MADE ri OCCUR 60414141 - 07/13/2018 07/13/2019 OAMAGETORENTED 100,000 d PREMISES/ny oautresoel— $ MED EXP(Any ane person) S 5,000 PERSONAL&ADV INJURY S 1,000,000 GENT.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2.000.000 .. X POLICY1-1 jECppT LOC PRODUCTS-COMPgPAGG S 2,000,000 OTHER: S A AUTOMOBILEUABIUTY IEOMMBBIINdEeDI)SINGLELIMIT S 1,000,000 ANY AUTO 60414141 07/13/2018 07113/2019 BODILY INJURY(Per person) S AUTOISDONLY X SCHEDULED BODILY INJURY(Per accident) S AURTEOS ONLY _ ATOSUONLY (Pge aEwe IOAMAGE S S A X UMBRELLA LIAR X OCCUR 1,000,000 EACH Of IRRENCE S EXCESS LIAR CLAIMS-MADE 60414141 07/13/2018 07/13/2019 AGGREGATE S DED X RETENTIONS 10,000 S 1,000,000 B WORKERS COMPENSATIONPER OTH- ANDEMPLOYERS'LIABILITY YIN X STATUTE FR ANY PROPRIETOERIPARTNERIEXECUTNE KSARP307864 OSN 112018 0511112019 E.L.EACH ACCIDENT S OM ICE100,000 R In SER EXCLUDED? NIA 100,000 E.L.DISEASE-EA EMPLOYEE S It yes.desmbe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY UNIT S A General Liability 60414141 07/1312018 07/13/2019 Damage on Rented Equ 100,000 DESCRIPTION OF OPERATIONS I LOCATIONSI VEHICLES (ACORD 101,Addltonal Remarks Schedule,may be attached 11 more space Is required) 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. Department of Finance&Administration Office of City Clerk 300 West Ash Street Suite 206 AUTHORIZED REPRESENTATIVE Salina,KS 67402 ACORD 25(2016/03) @ 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD