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Insurance Certificate `'v ° CERTIFICATE OF LIABILITY INSURANCE "'E'""."YYY' 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 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 NAME: Lambert Insurance Agency-Salina 'ANN, Ent: (78582S-2112 2310 Planet Ave. E-MAIL ) FAX INC No): (785)825-5166 ADDRESS: INSURER(S)AFFORDING COVERAGE NAILS I Salina KS'67401 INSURER A: VGM Specialty Underwrtiers INSURED INSURER B: Glynn Matteson INSURER c: _ _ _ DBA:Skip's Concessions INSURER D: 42 N. 170th Rd - INSURER - Salina KS 67401 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. NOTWTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH 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. ADD_5115 ILTR TYPE OF INSURANCE INSR VAN/ POLICY NUMBER- �MJPDF�FT I WD.. EXP I LIMITS GENERAL LIABILITY - EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE REN(EO PREMISES(Eaotarerce) i'100,000 CLAIMS-MADE ri OCCUR MED EXP(My one person) S 5,000 A CL1623281D 09/21/2018 09/21/2019. PERSONAL SADV puma S 1,000,000 GENERAL AGGREGATE S 2,000,000 GENL AGGREGATE LIMIT APPUES PER: PRODUCTS-COMP/OP AGO S 2,000,000 7 POLICY in;pi n LOC $ AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT S (Ea actiben0 ANY AUTO BODILY INJURY(Per person) S - ALLOWNED t��SCHEDULED BODILY INJURY(Per accident) S r AUTOS J AUTOS HIRED AUTOS H NON-OWNED PROPERTY DAMAGE , AUTOS (Per occident) S UMBRELLA LEASIu1 I�OCCUR - EACH OCCURRENCE S EXCESS LAB ' I CLAIMSJAADE AGGREGATE . S _ ETZT1I RETENTIONS A WORKERS COMPENSATION WC 57APIOTH- ANDEMPLOYERS'WIBILTY YIN TORY NIRS IFA ANY PROPRIETORAARTNERIEXECUTIVE X/A E.L EACH ACCIDENT S OFFTCERATEMBER EXCLUDED? ❑N (Mandatory In NH) E.L DISEASE-EA EMPLOYEE S. awN O . E.L DISEASE-POLICY LIMIT SeESsCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,AddlUonal Remarks•Schedule,It m_on sW_et is r.qu_Ind) RESTAURANT WITH NO SALE OF ALCOHOLIC BEVERAGES-WITHOUT SEATING CERTIFOCATE HOLDER IS ADDITIONAL INSURED. 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. PO BOX 736 SALINA AUTHORIZED REPRESENTATIVEKS 67402 4-art - - 4 a1'C. t. I I ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION.All rights reserved. • • The ACORD name and logo are registered marks.of ACORD