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Insurance Certificate
09/18/2020 AUTOS ONLYHIRED The ACORD name and logo are registered marks of ACORDCERTIFICATE HOLDER© 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03)AUTHORIZED REPRESENTATIVE CANCELLATION DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE LOCJECTPRO-POLICYGEN'L AGGREGATE LIMIT APPLIES PER:OCCURCLAIMS-MADECOMMERCIAL GENERAL LIABILITYPREMISES (Ea occurrence)$DAMAGE TO RENTEDEACH OCCURRENCE$MED EXP (Any one person)$PERSONAL & ADV INJURY$GENERAL AGGREGATE$PRODUCTS - COMP/OP AGG$$RETENTIONDEDCLAIMS-MADEOCCUR$AGGREGATE$EACH OCCURRENCE$UMBRELLA LIABDESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)INSRLTRTYPE OF INSURANCEPOLICY NUMBERPOLICY EFF(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)LIMITSPERSTATUTEOTH-ERE.L. EACH ACCIDENTE.L. DISEASE - EA EMPLOYEEE.L. DISEASE - POLICY LIMIT$$$ANY PROPRIETOR/PARTNER/EXECUTIVEIf yes, describe underDESCRIPTION OF OPERATIONS below(Mandatory in NH)OFFICER/MEMBER EXCLUDED?AND EMPLOYERS' LIABILITYWORKERS COMPENSATIONY / NAUTOMOBILE LIABILITYANY AUTOOWNEDSCHEDULEDNON-OWNEDAUTOS ONLYAUTOSAUTOS ONLYCOMBINED SINGLE LIMITBODILY INJURY (Per person)BODILY INJURY (Per accident)PROPERTY DAMAGE$$$$EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISTHIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INSDADDLWVDSUBRN / A$$(Ea accident)(Per accident)OTHER:REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESTHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISthis certificate does not confer rights to the certificate holder in lieu of such endorsement(s).If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement onIMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.COVERAGESCERTIFICATE NUMBER:REVISION NUMBER:INSUREDPHONE(A/C, No, Ext):PRODUCERADDRESS:E-MAILFAX(A/C, No):CONTACTNAME:NAIC #INSURER(S) AFFORDING COVERAGE ACCORDANCE WITH THE POLICY PROVISIONS.THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INSHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE67402-0736KSSalinaPO Box 736City of Salina1,000,00009/29/202109/29/2020A356708A2,000,0002,000,0001,000,000excluded100,0001,000,00009/29/202109/29/2020A356708YA20.21 All LinesWest Bend Mutual Insurance Company67401KSSalina400 Laura St.Bonnie Bays, DBA: Fun Foodsahess@yourassurance.com(785) 825-5098(800) 563-1871Ashley Hess67402-1213KSSalinaP.O. Box 1213201 E Iron AvenueAssurance Partners, LLC