Insurance CertificateDmjfou$;!3:5339 JYQDPS
EBUF!)NN0EE0ZZZZ*
BDPSE UN
DFSUJGJDBUF!PG!MJBCJMJUZ!JOTVSBODF
230310312:
UIJT!DFSUJGJDBUF!JT!JTTVFE!BT!B!NBUUFS!PG!JOGPSNBUJPO!POMZ!BOE!DPOGFST!OP!SJHIUT!VQPO!UIF!DFSUJGJDBUF!IPMEFS/!UIJT
DFSUJGJDBUF!EPFT!OPU!BGGJSNBUJWFMZ!PS!OFHBUJWFMZ!BNFOE-!FYUFOE!PS!BMUFS!UIF!DPWFSBHF!BGGPSEFE!CZ!UIF!QPMJDJFT
CFMPX/!UIJT!DFSUJGJDBUF!PG!JOTVSBODF!EPFT!OPU!DPOTUJUVUF!B!DPOUSBDU!CFUXFFO!UIF!JTTVJOH!JOTVSFS)T*-!BVUIPSJ\[FE
SFQSFTFOUBUJWF!PS!QSPEVDFS-!BOE!UIF!DFSUJGJDBUF!IPMEFS/
JNQPSUBOU;!Jg!uif!dfsujgjdbuf!ipmefs!jt!bo!BEEJUJPOBM!JOTVSFE-!uif!qpmjdz)jft*!nvtu!ibwf!BEEJUJPOBM!JOTVSFE!qspwjtjpot!ps!cf!foepstfe/
Jg!TVCSPHBUJPO!JT!XBJWFE-!tvckfdu!up!uif!ufsnt!boe!dpoejujpot!pg!uif!qpmjdz-!dfsubjo!qpmjdjft!nbz!sfrvjsf!bo!foepstfnfou/!B!tubufnfou!po
uijt!dfsujgjdbuf!epft!opu!dpogfs!boz!sjhiut!up!uif!dfsujgjdbuf!ipmefs!jo!mjfv!pg!tvdi!foepstfnfou)t*/
DPOUBDU
QSPEVDFS
Svui!Dpddp
OBNF;
GBY
QIPOF
VTJ!Jotvsbodf!Tfswjdft!MMD
595.865.2614 721.648.5:85
)B0D-!Op*;
)B0D-!Op-!Fyu*;
F.NBJM
2898!Tfousz!Qlxz!X/-!Wfwb!27
svui/dpddpAvtj/dpn
BEESFTT;
Tvjuf!411
JOTVSFS)T*!BGGPSEJOH!DPWFSBHFOBJD!$
Cmvf!Cfmm-!QB!!2:533
Bttpdjbufe!Joevtusjft!Jot/!Dp/-!Jod/34251
JOTVSFS!B!;
JOTVSFE
TubsTupof!Obujpobm!Jotvsbodf!Dpnqboz 365:7
JOTVSFS!C!;
JYQ!Dpsqpsbujpo
Usbwfmfst!Dpnnfsdjbm!Jotvsbodf!Dpnqboz 47248
JOTVSFS!D!;
Qsjodfupo!Gpssftubm!Wjmmbhf-
Obujpobm!Vojpo!Gjsf!Jot!Qjuutcvshi-!QB 2:556
JOTVSFS!E!;
214!Nbjo!Tusffu!Tvjuf!211
Mjcfsuz!Jotvsbodf!Voefsxsjufst-!Jod/2::28
JOTVSFS!F!;
Qsjodfupo-!OK!!19651
JOTVSFS!G!;
DPWFSBHFT DFSUJGJDBUF!OVNCFS;SFWJTJPO!OVNCFS;
UIJT!!JT!!UP!!DFSUJGZ!!UIBU!!UIF!!QPMJDJFT!!PG!!JOTVSBODF!!MJTUFE!!CFMPX!!IBWF!CFFO!JTTVFE!!UP!UIF!!JOTVSFE!!OBNFE!BCPWF!!GPS!UIF!!QPMJDZ!QFSJPE
JOEJDBUFE/!!!OPUXJUITUBOEJOH!!BOZ!!!SFRVJSFNFOU-!!UFSN!!PS!!DPOEJUJPO!PG!!BOZ!!DPOUSBDU!PS!!PUIFS!!EPDVNFOU!!XJUI!!SFTQFDU!!UP!!XIJDI!!UIJT
DFSUJGJDBUF!!NBZ!!CF!!JTTVFE!!PS!!NBZ!!QFSUBJO-!!!UIF!!JOTVSBODF!!BGGPSEFE!!CZ!!UIF!!QPMJDJFT!!EFTDSJCFE!!IFSFJO!!JT!!TVCKFDU!!UP!!BMM!!UIF!!UFSNT-
FYDMVTJPOT!!BOE!!DPOEJUJPOT!!PG!!TVDI!!QPMJDJFT/!!!MJNJUT!!TIPXO!!NBZ!!IBWF!!CFFO!!SFEVDFE!!CZ!!QBJE!!DMBJNT/
JOTS BEEMTVCS QPMJDZ!FGGQPMJDZ!FYQ
UZQF!PG!JOTVSBODF MJNJUT
QPMJDZ!OVNCFS
MUS)NN0EE0ZZZZ*)NN0EE0ZZZZ*
JOTSXWE
DPNNFSDJBM!HFOFSBM!MJBCJMJUZ
FBDI!PDDVSSFODF%
B Y BFT21467:216 190420312:1904203131 2-111-111
EBNBHF!UP!SFOUFE
%
Y 211-111
DMBJNT.NBEFPDDVS
QSFNJTFT!)Fb!pddvssfodf*
NFE!FYQ!)Boz!pof!qfstpo*%
1
QFSTPOBM!'!BEW!JOKVSZ%
2-111-111
HFO(M!BHHSFHBUF!MJNJU!BQQMJFT!QFS;
HFOFSBM!BHHSFHBUF%3-111-111
QSP.
Y QSPEVDUT!.!DPNQ0PQ!BHH%3-111-111
QPMJDZ KFDU MPD
%
PUIFS;
DPNCJOFE!TJOHMF!MJNJU
BVUPNPCJMF!MJBCJMJUZ
B BFT21467:216 190420312:1904203131 2-111-111
)Fb!bddjefou*%
CPEJMZ!JOKVSZ!)Qfs!qfstpo*%
BOZ!BVUP
PXOFE TDIFEVMFE
CPEJMZ!JOKVSZ!)Qfs!bddjefou*%
BVUPT!POMZ
BVUPT
IJSFE OPO.PXOFE QSPQFSUZ!EBNBHF
%
Y Y
BVUPT!POMZ
)Qfs!bddjefou*
BVUPT!POMZ
%
VNCSFMMB!MJBC
C
FBDI!PDDVSSFODF%
PDDVS 6:295E2:5BMJ 190420312:1904203131 6-111-111
FYDFTT!MJBC
DMBJNT.NBEF BHHSFHBUF%
Y Y 6-111-111
%
Y 1
EFE SFUFOUJPO%
QFS PUI.
XPSLFST!DPNQFOTBUJPO
D VC114L87795:12012031311201203132 Y
TUBUVUF FS
BOE!FNQMPZFST(!MJBCJMJUZ
Z!0!O
BOZ!QSPQSJFUPS0QBSUOFS0FYFDVUJWF
F/M/!FBDI!BDDJEFOU%
2-111-111
O!0!B
PGGJDFS0NFNCFS!FYDMVEFE@
O
)Nboebupsz!jo!OI*
F/M/!EJTFBTF!.!FB!FNQMPZFF%2-111-111
Jg!zft-!eftdsjcf!voefs
F/M/!EJTFBTF!.!QPMJDZ!MJNJU%2-111-111
EFTDSJQUJPO!PG!PQFSBUJPOT!cfmpx
E Qspgfttjpobm 127973185 190420312:1904203131%6-111-111
F Fydftt!Mjbc.FP5OBBT5KX119190420312:1904203131%6-111-111!Fydftt
EFTDSJQUJPO!PG!PQFSBUJPOT!0!MPDBUJPOT!0!WFIJDMFT!)BDPSE!212-!Beejujpobm!Sfnbslt!Tdifevmf-!nbz!cf!buubdife!jg!npsf!tqbdf!jt!sfrvjsfe*
Uif!Hfofsbm!Mjbcjmjuz-!Bvup!Mjbcjmjuz-!boe!Vncsfmmb!!qpmjdz)t*!jodmveft!bo!bvupnbujd!Beejujpobm!Jotvsfe
foepstfnfou!uibu!qspwjeft!Beejujpobm!Jotvsfe!tubuvt!up!uif!Djuz!pg!Tbmjob-!Tbmjob!Qpmjdf!Efqu!!!pomz!xifo
uifsf!jt!b!xsjuufo!dpousbdu!uibu!sfrvjsft!tvdi!tubuvt-!boe!pomz!xjui!sfhbse!up!xpsl!qfsgpsnfe!po!cfibmg!pg
uif!obnfe!jotvsfe/
Uif!Hfofsbm!Mjbcjmjuz!!qpmjdz)t*!dpoubjot!b!tqfdjbm!foepstfnfou!xjui!#Qsjnbsz!boe!Opodpousjcvupsz#!xpsejoh-
)Tff!Buubdife!Eftdsjqujpot*
DFSUJGJDBUF!IPMEFS DBODFMMBUJPO
TIPVME!BOZ!PG!UIF!BCPWF!EFTDSJCFE!QPMJDJFT!CF!DBODFMMFE!CFGPSF
Djuz!pg!Tbmjob
UIF!!!!FYQJSBUJPO!!!EBUF!!!!UIFSFPG-!!!!OPUJDF!!!XJMM!!!CF!!!EFMJWFSFE!!!JO
BDDPSEBODF!!!XJUI!!!UIF!!!QPMJDZ!!!QSPWJTJPOT/
Tbmjob!Qpmjdf!Efqbsunfou
Tfbo!Npsupo0!Efqvuz!Dijfg
BVUIPSJ\[FE!SFQSFTFOUBUJWF
366!O!21ui!Tusffu
Tbmjob-!LT!!78512
ª!2:99.3126!BDPSE!DPSQPSBUJPO/!Bmm!sjhiut!sftfswfe/
BDPSE!36!)3127014*Uif!BDPSE!obnf!boe!mphp!bsf!sfhjtufsfe!nbslt!pg!BDPSE
22 pg!3pg!3
$T3855321:0N3844:127$T3855321:0N3844:127 SYDGU
EFTDSJQUJPOT!)Dpoujovfe!gspn!Qbhf!2*
xifo!sfrvjsfe!cz!xsjuufo!dpousbdu/
Uif!Hfofsbm!Mjbcjmjuz!boe!Vncsfmmb!!qpmjdz)t*!qspwjef!b!Cmbolfu!Xbjwfs!pg!Tvcsphbujpo!xifo
sfrvjsfe!cz!xsjuufo!dpousbdu-!fydfqu!bt!qspijcjufe!cz!mbx/
TBHJUUB!36/4!)3127014*
3 pg!3
$T3855321:0N3844:127
Client#:294228 IXPCOR
ACORDr. CERTIFICATE OF LIABILITY INSURANCE DATE(MIMDDNYYY)
8/20/2019
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 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 any rights to the certificate holder In lieu of such endorsement(s).
PRODUCER 1CONTSACT
PHO
USI Insurance Services LLC PHONE
NO,Ezl): R.I(NC,No):
1787 Sentry Pkwy W.,Veva 16 ADDRE
Suite 300 ADDRESS:
Blue Bell, PA 19422 INSURER(S)AFFORDING COVERAGE NAIL a
IINSURER A:Avoclaud InduaaW an.CO.as 23140
INSURED INSURER B:SmiStore Nancnai anuranucamweny 25496
IXP Corporation TraMemco,m !nuance 36137
Princeton Forrestal Village, INSURER C:
I INSURER D:Rnbn&UNPn nre w Plrtapndq PA 19445
103 Main Street Suite 100 Ub.nyenuranceUrd..W,eetLIns. 19917
Princeton, NJ 08540 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 CONTRACTOR 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 ADDLSUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSR IV/VD I POUCY NUMBER (MaNDDIYYYY)I(MMIDD/YYYY)I LIMITS
A X COMMERCIAL GENERALLUABIUTY AES103569105 08/31/2019 08/31/2020 EACH OCCURRENCE $1,000,000
RA
I CLAIMS-MADE I X OCCUR I PEREMISES(=_a o Pence 15100,000
I I MED EXP(Any one person) I 5 0
I PERSONAL XADV INJURY 51,000,000
GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s2,000,000
I POLICY X E T I I LOC PRODUCTS-COMP/OPAGG 152,000,000
_ I OTHER: s
AUTOMOBILE LIABILITY COMBINED SWGLE LIMIT
A I AES103569105 08/31/2019 08/31/2020(Eaaccitleml 51,000,000
ANY AUTO BODILY INJURY(Per person) I s
OWNED SCHEDULED BODILY INJURY(Per accident) 5
HIRED ONLY NITOS
X AUTOS ONLY I X . OSOS NON-OWNEDONLY I P(PefOP ddentl DAMAGE 15
5
B IUMBRELLA UAB I OCCUR 59184D194ALI 08/31/2019 08/31/202d EACH OCCURRENCE s5,000,000
xi EXCESS UAB I X CLAIMS-MADE AGGREGATE s5,000,000
I DED XI RETENTIONS0 5
C WORKERS COMPENSATION UB003K766849 01/01/2019 01/01/2020 X IMTUTE I IFR
AND EMPLOYERS'LIABILITY
ANY PROPRIETOR/PARTNERIEXECtVEY/N
mEL EACH ACCIDENT 51000,000
OFFICERin R EXCLUDED? NIA
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE 51,000,000
If yes,describe under
_ ,DESCESCRIPTIONOFOPERATIONS below _ E.LDISEASE-POLICYLIMIT 157,000,000
D Professional 18327375 08/31/2019 08/31/2020 55,000,000
E Excess Liab- EO4NAAS4JW008 08/31/2019 08/31/2020$ 5,000,000 Excess
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached II more space Is required)
The General Liability,Auto Liability,and Umbrella policy(s)includes an automatic Additional Insured
endorsement that provides Additional Insured status to the City of Salina,Salina Police Dept only when
there is a written contract that requires such status,and only with regard to work performed on behalf of
the named insured.
The General Liability policy(s)contains a special endorsement with"Primary and Noncontributory"wording,
(See Attached Descriptions)
CERTIFICATE HOLDER CANCELLATION
Salina Police Department Sean SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
P THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Morton/Deputy Chief ACCORDANCE WITH THE POLICY PROVISIONS.
255 N 10th Street
Salina, KS 67401 AUTHORIZED REPRESENTATIVE
®1988-2015 ACORD CORPORATION.All rights reserved.
ACORD 25(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD
#526399157/M26393844 ADKZP
DESCRIPTIONS (Continued from Page 1)
when required by written contract.
The General Liability and Umbrella policy(s)provide a Blanket Waiver of Subrogation when
required by written contract,except as prohibited by law.
SAGITTA 25.3(2016/03) 2 of 2
#S26399157/M26393844
Client#:294228 IXPCOR
ACORD., CERTIFICATE OF LIABILITY INSURANCE DATE(IIWDLINYYY)
8/29/2018
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 any rights to the certificate holder in lieu of such endorsement(s).
PRODUCEflOONTACT
USI Insurance Services LLC (PHONE FAX
(A,c,No,Ea):464 351-0600 I(uc,No): 610 537-0974
1787 Sentry Pkwy W.,Veva 16 E-MAIL
Suite 300 ADDRESS:
INSURER(S)AFFORDING COVERAGE NAIL e
Blue Bell, PA 19422
I INSURER A:Ass ciatee kidunnes Inn Co.Inc. 23140
INSURED INSURER B:Starstane wova aansncs conpanr 25496
IXP Corporation
INSURER C „Trav oo m ntWInsuranceCnmpany 36137
Princeton Forrestal Village, I INSURER D:Nana'moon cue w Mr-starch.PA 19445
103 Main Street Suite 100 I INSURER E:Lmany auunrce U^oemeM.Inc. 19917
Princeton,NJ 08540
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.
INSRADDLSUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE IINSR IWVD POLICY NUMBER (MWDDIYYYY)I(MWDINTYYY) LIMITS
A xi COMMERCIAL GENERAL LIABILITY AES103569104 08/31/2018 08/31/2019 EACH OCCURRENCE 51,000,000
I CLAIMS-MADE X OCCUR PREMISES{Eaomnence) S100,000
I I MED EXP(Any one person) SO
I PERSONAL&ADV INJURY 51,000,000
GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
I POLICY I I EC 17 LOC IPRODUCTS-COMP/OPAGG (52,000,000
I OTHER: I S
A I AUTOMOBILE LIABILITY AES103569104 08/31/2018 08/31/2019 COMBINED SINGLE LIMrz
.(Ea arr+dnnn I S1,000,000
I I MY AUTO BODILY INJURY(Per person) IS
I?PROWS AUTOS�D BODILY INJURY(Per accident) $
X I AUTOS ONLY I X I ED NON-OWNED
ONLY (PROPERTYr ient9AMAGE S
I I I I IS
B I UMBRELLA LIAR I OCCUR 59184D183ALI 08/31/2018 08/31/2019 EACH OCCURRENCE s5,000,000
XI EXCESS UAB I X CLAIMS-MADE AGGREGATE $5,000,000
DED I XI RETENTION$0 $
C WORKERS COMPENSATION UB003K766849 01/01/2018 01/01/2019 X IPER oTH-
NDEMPLOYERS'UABILITY V/N STAME FR
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT 51,000000
OFFICEFUMEMBER EXCLUDED? N N/A 1
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
D Professional Liab 18336672 08/31/2018 08/31/2019 $5,000,000
E Excess Liab- EO4NAAS4JW006 08/31/2018 08/31/2019 Excess$5,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached II more space is required)
The General Liability,Auto Liability,and Umbrella policy(s)includes an automatic Additional Insured
endorsement that provides Additional Insured status to the City of Salina only when there is a written
contract that requires such status,and only with regard to work performed on behalf of the named insured.
The General Liability policy(s)contains a special endorsement with"Primary and Noncontributory"wording,
when required by written contract.
(See Attached Descriptions)
CERTIFICATE HOLDER CANCELLATION
Cityof Salina, Kansas SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
300 W Ash ACCORDANCE WITH THE POLICY PROVISIONS.
Salina, KS 67401
AUTHORIZED REPRESENTATIVE
I - y -C
®1988-2015 ACORD CORPORATION.All rights reserved.
ACORD 25(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD
#S23762109/M23761305 AXYZP
DESCRIPTIONS (Continued from Page 1)
The General Liability and Umbrella policy(s)provide a Blanket Waiver of Subrogation when
required by written contract,except as prohibited by law.
SAGITTA 25.3(2016/03) 2 of 2
#S23762109/M23761305