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Insurance Certificate - Kenwood Cove Concession 0Nationwide® FEBRUARY 4, 2021 is on your side V9 1 Z ? �'� 08028 goral ASSURANCE PARTNERS LLC SALINA KS 67402 Nationwide Mutual Insurance Company Midwest Regional Operations PO Box 183117 Columbus OH 43218-3117 CITY OF SALINA 300 W ASH SALINA, KS 67401-2335 Insured: SUMMIT VENTURES LLC Policy No.: ACP BA 3017795448 Vehicle or Location Interest Applies to: We have taken the following action on this policy: x The above policy has been cancelled effective 07-13-20 The on the above policy has been deleted effective Your name on the above policy has been deleted as Loss Payee / Mortgagee effective You have been deleted as Certificate Holder effective The continuation premium was not paid when due and the policy terminated on the expiration date, which was Underwriting Department Nationwide Mutual Insurance Company z n v w N 1 N O 21 11643(06-10) 8 Page 1 of 1 2 READ ADDITIONAL INTEREST NOTIFICATIONS VE6 You are receiving this item on behalf of NATIONWIDE GMUTUAL because the policy listed includes you as an 'additional interest'. Please contact the Producer/Agency or company directly for additional information or to make 11111111111111111111111111111111111111111111111111111011111 any changes. 02-05-2021 00000000 0075285533 00000000 V 00000001 9932-1/1 9932: Do NOT send or make checks payable to CV-Exchange Transactions may print on front and back.Please check each **T30/P189**********AUTO**MIXED AADC 500 side of every page. CITY OF SALINA 300 W ASH ST SALINA KS 67401-2335 lIlIIlllrlrlllIIllllIIIIIIIIIIIuIIIII IIIIII IIII IIIIIIIIIII'I'lIII NATIONWIDE MUTUAL 23787 Cancelled-Insured Request Policy Information: Aden Insd: Producer:08028 Policy Number:ACPBA3007795448 Effective Date:07/13/2020 City Of Salina Phone:(800)563-1871 2015 TOYOTA TUNDRA PIC 5TFBW5F18FX431951 300 W Ash Assurance Partners LLC Salina,KS 67401-2335 PO Box 1213 Insured: Summit Ventures LLC Salina,KS 67402-1213 Kbi Meats LLC PO Box 3316 Salina,KS 67402-3316 For Additional Information Contact Producer You are hereby notified within the terms and conditions of the above mentioned policy that the insurance will cease at 12:01 AM on 07/13/2020. 02-05-2021 0000000 0075285533 0504079233 0118 IC V Page 1 of 1 Aco® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) kr.....-/ 05/26/2020 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 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 CONTACT Amber Bell NAME: Assurance Partners,LLC PHONE (800)563-1871 FAX (785)825-5098 AIC,No,Eat): (A/C,No): 201 E Iron Avenue E-MAIL abell@yourassurance.com ADDRESS: P.O.Box 1213 INSURER(S)AFFORDING COVERAGE NAIC# Salina KS 67402-1213INSURERA: Nationwide Mutual Insurance Company 23787 INSURED INSURER B: KS Restaurant&Hospitality Summit Ventures LLC INSURER C: KBI Meats,LLC INSURER D: PO Box 3316 INSURER E: Salina KS 67402-3316 INSURER F: COVERAGES CERTIFICATE NUMBER: 20.21 All lines 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 AUDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DDIYYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO REN rED 300,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 1,000 A Y Y ACP3017795448 06/01/2020 06/01/2021 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JECT PRO LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED Y Y ACP3017795448 06/01/2020 06/01/2021 BODILY INJURY(Peraccident) $ AUTOS ONLY AUTOS _ X HIRED ONLY X NON-OOS ONLWNEY D PROPERTY DAMAGE (Per accident) $ A _ AUT $ X UMBRELLA LIAB OCCUR EACH OCCURRENCES 1,000,000 A EXCESS LIAB CLAIMS-MADE ACP3017795448 06/01/2020 06/01/2021 AGGREGATE $ 1,000,000 DED X RETENTION$ 0 $ WORKERS COMPENSATION X STATUTE EORH AND EMPLOYERS'LIABILITY YIN B ANY PROPRIETOR/PARTNER/EXECUTIVE N/A Y 10667 01/01/2020 01/01/2021 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ , DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Kenwood Cove Concession PB6003,PB0497,AC9901,CA0444 Concessions for Magnolia Soccer Complex 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. 300 WAsh AUTHORIZED REPRESENTATIVE Salina KS 67401 *A0 e IIN ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD BUSINESSOWNERS PB 60 03 04 11 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MUNICIPALITIES OR PUBLIC AGENCY - INSURED PROVIDING PROFESSIONAL SERVICES This endorsement modifies insurance provided under the following: PREMIER BUSINESSOWNERS LIABILITY COVERAGE FORM The following is added to Section II. WHO IS AN professional services, advice of instruction, subject INSURED: to the following additional exclusion: The municipality and/or public agency designated in This insurance, including any duty we have to the Schedule of this endorsement is also an insured, defend"suits", does not apply to"bodily injury", but only with respect to liability for"bodily injury", "property damage"or"personal and advertising "property damage"or"personal and advertising injury"that arises out of, in whole or in part, or is a injury" caused ,in whole or in part, by your acts or result of, in whole or in part, the active or primary omissions or the acts or omissions of those acting negligence of the municipality and/or public agency on your behalf in connection with your operations, designated in the Schedule of this endorsement, other than the rendering of or the failure to render whether or not such negligence has been assumed by you in a contract or agreement. All terms and conditions of this policy apply unless modified by this endorsement. SCHEDULE Municipality and/or Public Agency: THE CITY OF SALINA 300 W ASH ST RM 100 SALINA KS 674012335 PB 60 03 04 11 Page 1 of 1 ACP BPFD3077795448 AGENT COPY 43 16618 BUSINESSOWNERS PB 04 97 07 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: PREMIER BUSINESSOWNERS COMMON POLICY CONDITIONS SCHEDULE Name Of Person Or Organization: THE CITY OF SALINA 300 W. ASH ST., ROOM 100 SALINA KS 67401 In condition K. TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US, under paragraph 2. Applicable to Businessowners Liability Coverage, the following paragraph is added: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or"your work"done under a contract with that person or organization and included in the "products-completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. All terms and conditions of this policy apply unless modified by this endorsement. Includes copyrighted material of Insurance Services Office, Inc.,with its permission. © ISO Properties, Inc., 2004 PB 04 97 07 07 Page 1 of 1 ACP BPFC3017795448 INSURED COPY 43 03217 Kansas Restaurant& Hospitality Association Self-Insurance Fund THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHTS TO RECOVER FROM OTHERS ENDORSEMENT Policy Number: 10667 Endorsement Number: 1 Effective Date: 05/29/2018 (Effective hour is the same as stated on the Information Page of the policy.) Named Insured and Address: Summit Ventures,LLC DBA Wendy's PO Box 3316 Salina,KS 67401 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 shall not operate directly or indirectly to benefit anyone not named in the Schedule. SCHEDULE City of Salina, 300 W Ash, Salina, KS 67401 Countersigned by Authorized Representative BUSINESS AUTO AC 99 01A 06 97 KANSAS ADDITIONAL NAMED INSURED SCHEDULE Additional Named Insured and Address TOD ELAND 1940 S OHIO SALINA, KS 67401-6643 Insurance Company NATIONWIDE MUTUAL INSURANCE COMPANY Agent Name and Address ASSURANCE PARTNERS LLC 08028-264 002 SALINA KS 67402-1213 Insured Name and Address SUMMIT VENTURES LLC PO BOX 3316 SALINA, KS 67402-3316 Policy Number ACP BA 30-1-7795448 Effective Date 06/01/2020 Expiration Date 06/01/2021 Described Owned Motor Vehicle Coverages (Limits/Deductibles) Year, Make and VIN Liability No Fault Comprehensive/ Collision Specified Causes of Loss 2 2015 TOYOTA 1,000,000 50 500 500 5TFBW5F18FX431951 AC 99 01A 05 97 Copyright, Insurance Services Office, Inc 1995 Page 1 of 2 ACP BA 30-1-7795448 LEV1 202009 INSURED COPY 43 0003236 AC 99 01A 05 97 This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM A. APPLICATION B. LOSS PAYABLE CLAUSE 1. Any vehicle described in the Schedule will 1. We will pay, as interest may appear, you be considered a covered "auto" you own and the owner named in the Schedule for and not a covered "auto"you hire, borrow "loss"to a covered "auto". or lease under the coverage for which it is 2. The insurance covers the interest of the a covered "auto". owner unless the "loss" results from 2. LIABILITY COVERAGE and Personal conversion, secretion, or embezzlement on Injury Protection as prescribed in the your part. Kansas Automobile Injury Reparations Act 3. We may cancel the policy as allowed by the will apply to each owner named in the CANCELLATION Common Policy Schedule as an additional named insured Conditions. but only while the motor vehicle described 4. If we make any payment to the owner, we in the Schedule is being used by you or on will obtain his or her rights against any other your behalf. party. 3. The insurance will apply to the owner only while the described vehicle is leased to you. All terms and conditions of this policy apply unless modified by this endorsement. Page 2 of 2 Copyright, Insurance Services Office, Inc 1995 AC 99 01A 05 07 ACP BA 30-1-7795448 LEVI 202009 INSURED COPY 43 0003237 COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. SCHEDULE Name(s)Of Person(s)Or Organization(s): CITY OF SALINA Information required to complete this Schedule, if not shown above,will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. CA 04 4410 13 ©Insurance Services Office, Inc., 2011 Page 1 of 1 L7DM 18129 INSURED COPY CA0444101300 0200 43 0002380 DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 03/03/2020 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 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). CONTACT PRODUCER Amber Bell NAME: FAX PHONE Assurance Partners(800) 563-1871(785) 825-5098 (A/C, No): (A/C, No, Ext): E-MAIL 201 E Iron Avenue abell@yourassurance.com ADDRESS: P.O. Box 1213 INSURER(S) AFFORDING COVERAGENAIC # Salina KS67402-1213 Nationwide Mutual Insurance Company23787 INSURER A : INSURED KS Restaurant & Hospitality INSURER B : Summit Ventures LLC INSURER C : KBI Meats, LLC INSURER D : PO Box 3316 INSURER E : Salina KS67402-3316 INSURER F : 19.20/20.21 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. ADDLSUBR INSR POLICY EFFPOLICY EXP TYPE OF INSURANCE LIMITS POLICY NUMBER LTR(MM/DD/YYYY)(MM/DD/YYYY) INSDWVD COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE$ DAMAGE TO RENTED 300,000 CLAIMS-MADEOCCUR$ PREMISES (Ea occurrence) 1,000 MED EXP (Any one person)$ A Y Y ACP300779544806/01/2019 06/01/2020 1,000,000 PERSONAL & ADV INJURY$ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- 2,000,000 POLICY LOC PRODUCTS - COMP/OP AGG$ JECT $ OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY 1,000,000 $ (Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNED SCHEDULED A Y Y ACP300779544806/01/2019 06/01/2020 BODILY INJURY (Per accident)$ AUTOS ONLYAUTOS HIRED NON-OWNED PROPERTY DAMAGE $ (Per accident) AUTOS ONLYAUTOS ONLY Uninsured motorist BI-1,000,000 $ single limit UMBRELLA LIAB 1,000,000 OCCUR EACH OCCURRENCE$ A EXCESS LIAB ACP300779544806/01/2019 06/01/2020 1,000,000 CLAIMS-MADE AGGREGATE$ 0 DED RETENTION$$ PER OTH- WORKERS COMPENSATION STATUTEER AND EMPLOYERS' LIABILITY Y / N 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT$ B N / A Y 10667 01/01/202001/01/2021 OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Kenwood Cove Concession PB6003, PB0497, AC9901, CA0444 Concessions for Magnolia Soccer Complex This is a revised certificate and supersedes any previously issued certificate. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Salina 300 W Ash AUTHORIZED REPRESENTATIVE Salina KS67401 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD BUSINESSOWNERS PB60030411 THISENDORSEMENTCHANGESTHEPOLICY.PLEASEREADITCAREFULLY. ADDITIONALINSURED–MUNICIPALITIESOR PUBLIC AGENCY–INSUREDPROVIDING PROFESSIONAL SERVICES Thisendorsementmodifiesinsuranceprov idedunderthefollowing: PREMIERBUSINESSOWNERSLIABILITYCOVERAGEFORM professionalservices,adviceofinstruction,subject Thefollowingis addedtoSectionII.WHOISAN tothefollowingadditionalexclusion: INSURED: Thisinsurance,includinganydutywehaveto Themunicipalityand/orpublicagency designatedin defend"suits",doesnotapplyto"bodilyinju ry", theScheduleofthisendorsementisalsoaninsured, "propertydamage"or"personalandadvertising butonlywithrespecttoli abilityfor“bodilyinjury”, injury"thatarisesoutof,inwholeorinpart,orisa “propertydamage”or“personalandadvertising resultof,inwholeorinpart,theactiveorprimary injury”caused,inwholeorinpart,byyouractsor negligenceofthemunicipalityand/orpublicagency omissionsortheactsoromissionsofthoseacting designatedintheScheduleofthisendorsement, onyourbehalfinconnectionwithyouroperations, whetherornotsuchnegligencehasbeenassumed otherthantherendering oforthefailuretorender byyouinacontractoragreement. Alltermsandc onditionsofthispolicyapplyunlessmodifiedbythisendorsement. SCHEDULE Municipalityand/orPublicAgency: THECITYOFSALINA 300W ASHSTRM 100 SALINAKS 674012335 PB60030411 Page1of1 ACPBPFD3077795448AGENTCOPY4316618 THECITYOFSALINA 300W.ASHST.,ROOM100 SALINAKS67401 ACPBPFD3077795448AGENTCOPY4316617 CITY OF SALINA 300 WASH SALINA,KS 67401-2335 NATIONWIDEMUTUALINSURANCECOMPANY ASSURANCEPARTNERSLLC08028-264 002 SALINAKS67402-1213 SUMMITVENTURES LLC POBOX3316 SALINA,KS67402-3316 ACPBA30-9-7795448 06/01/201806/01/2019 21,000,00050500500 2015TOYOTA 5TFBW5F18FX431951 ACPBA30-9-7795448L7DM201812INSUREDCOPY430002351 ACPBA30-9-7795448L7DM201812INSUREDCOPY430002352 COMMERCIALAUTO CA04441013 THISENDORSEMENTCHANGESTHEPOLICY.PLEASEREADITCAREFULLY. WAIVEROF TRANSFEROF RIGHTSOF RECOVERY AGAINSTOTHERSTO US(WAIVEROF SUBROGATION) Thisendorsementmodifiesinsuranceprovided underthefollowing: AUTODEALERSCOVERAGEFORM BUSINESSAUTOCOVERAGEFORM MOTORCARRIERCOVERAGEFORM Withrespecttocoverageprovidedbythisendorsement,theprovisionsoftheCoverageFormapplyunless modifiedbytheendorsement. SCHEDULE Name(s)OfPerson(s)OrOrganization(s): CITYOFSALINA InformationrequiredtocompletethisSchedule,ifnotshownabove,willbeshownintheDeclarations. The TransferOfRightsOf RecoveryAgainst OthersToUs conditiondoesnotapplytothe person(s)ororganization(s)shownintheSchedule, butonlytotheextentthatsubrogationiswaivedprior tothe"accident"orthe"loss"underacontractwith thatpersonororganization. CA04441013©InsuranceServicesOffice,Inc.,2011 Page1of1 ACPBA30-9-7795448L7DM18129IN SUREDCOPYCA04441013000200430002380 DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 05/22/2019 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 rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER Alexi Mai NAME: FAX PHONE Assurance Partners(800) 563-1871(785) 825-5098 (A/C, No): (A/C, No, Ext): E-MAIL 201 E Iron Avenue amai@yourassurance.com ADDRESS: P.O. Box 1213 INSURER(S) AFFORDING COVERAGENAIC # Salina KS67402-1213 Nationwide Mutual Insurance Company23787 INSURER A : INSURED KS Restaurant & Hospitality INSURER B : Summit Ventures LLC INSURER C : KBI Meats, LLC INSURER D : PO Box 3316 INSURER E : Salina KS67402-3316 INSURER F : 19.20 Pkg Renewal 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. ADDLSUBR INSR POLICY EFFPOLICY EXP TYPE OF INSURANCE LIMITS POLICY NUMBER LTR(MM/DD/YYYY)(MM/DD/YYYY) INSDWVD COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE$ DAMAGE TO RENTED 300,000 CLAIMS-MADEOCCUR$ PREMISES (Ea occurrence) 1,000 MED EXP (Any one person)$ A Y Y ACP300779544806/01/2019 06/01/2020 1,000,000 PERSONAL & ADV INJURY$ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- 2,000,000 POLICY LOC PRODUCTS - COMP/OP AGG$ JECT $ OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY 1,000,000 $ (Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNED SCHEDULED A Y Y ACP300779544806/01/2019 06/01/2020 BODILY INJURY (Per accident)$ AUTOS ONLYAUTOS HIRED NON-OWNED PROPERTY DAMAGE $ (Per accident) AUTOS ONLYAUTOS ONLY $ UMBRELLA LIAB 1,000,000 OCCUR EACH OCCURRENCE$ A EXCESS LIAB ACP300779544806/01/2019 06/01/2020 1,000,000 CLAIMS-MADE AGGREGATE$ 0 DED RETENTION$$ PER OTH- WORKERS COMPENSATION STATUTEER AND EMPLOYERS' LIABILITY Y / N 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT$ B N / A Y 10667 01/01/201901/01/2020 OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Kenwood Cove Concession PB6003, PB0497, AC9901, CA0444 Concessions for Magnolia Soccer Complex This is a revised certificate and supersedes any previously issued certificate. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Salina 300 W Ash AUTHORIZED REPRESENTATIVE Salina KS67401 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD BUSINESSOWNERS PB60030411 THISENDORSEMENTCHANGESTHEPOLICY.PLEASEREADITCAREFULLY. ADDITIONALINSURED–MUNICIPALITIESOR PUBLIC AGENCY–INSUREDPROVIDING PROFESSIONAL SERVICES Thisendorsementmodifiesinsuranceprov idedunderthefollowing: PREMIERBUSINESSOWNERSLIABILITYCOVERAGEFORM professionalservices,adviceofinstruction,subject Thefollowingis addedtoSectionII.WHOISAN tothefollowingadditionalexclusion: INSURED: Thisinsurance,includinganydutywehaveto Themunicipalityand/orpublicagency designatedin defend"suits",doesnotapplyto"bodilyinju ry", theScheduleofthisendorsementisalsoaninsured, "propertydamage"or"personalandadvertising butonlywithrespecttoli abilityfor“bodilyinjury”, injury"thatarisesoutof,inwholeorinpart,orisa “propertydamage”or“personalandadvertising resultof,inwholeorinpart,theactiveorprimary injury”caused,inwholeorinpart,byyouractsor negligenceofthemunicipalityand/orpublicagency omissionsortheactsoromissionsofthoseacting designatedintheScheduleofthisendorsement, onyourbehalfinconnectionwithyouroperations, whetherornotsuchnegligencehasbeenassumed otherthantherendering oforthefailuretorender byyouinacontractoragreement. Alltermsandc onditionsofthispolicyapplyunlessmodifiedbythisendorsement. SCHEDULE Municipalityand/orPublicAgency: THECITYOFSALINA 300W ASHSTRM 100 SALINAKS 674012335 PB60030411 Page1of1 ACPBPFD3077795448AGENTCOPY4316618 THECITYOFSALINA 300W.ASHST.,ROOM100 SALINAKS67401 ACPBPFD3077795448AGENTCOPY4316617 CITY OF SALINA 300 WASH SALINA,KS 67401-2335 NATIONWIDEMUTUALINSURANCECOMPANY ASSURANCEPARTNERSLLC08028-264 002 SALINAKS67402-1213 SUMMITVENTURES LLC POBOX3316 SALINA,KS67402-3316 ACPBA30-9-7795448 06/01/201806/01/2019 21,000,00050500500 2015TOYOTA 5TFBW5F18FX431951 ACPBA30-9-7795448L7DM201812INSUREDCOPY430002351 ACPBA30-9-7795448L7DM201812INSUREDCOPY430002352 COMMERCIALAUTO CA04441013 THISENDORSEMENTCHANGESTHEPOLICY.PLEASEREADITCAREFULLY. WAIVEROF TRANSFEROF RIGHTSOF RECOVERY AGAINSTOTHERSTO US(WAIVEROF SUBROGATION) Thisendorsementmodifiesinsuranceprovided underthefollowing: AUTODEALERSCOVERAGEFORM BUSINESSAUTOCOVERAGEFORM MOTORCARRIERCOVERAGEFORM Withrespecttocoverageprovidedbythisendorsement,theprovisionsoftheCoverageFormapplyunless modifiedbytheendorsement. SCHEDULE Name(s)OfPerson(s)OrOrganization(s): CITYOFSALINA InformationrequiredtocompletethisSchedule,ifnotshownabove,willbeshownintheDeclarations. The TransferOfRightsOf RecoveryAgainst OthersToUs conditiondoesnotapplytothe person(s)ororganization(s)shownintheSchedule, butonlytotheextentthatsubrogationiswaivedprior tothe"accident"orthe"loss"underacontractwith thatpersonororganization. CA04441013©InsuranceServicesOffice,Inc.,2011 Page1of1 ACPBA30-9-7795448L7DM18129IN SUREDCOPYCA04441013000200430002380