Insurance ARD® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY)
04/01/2021
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 Erin Burch
NAME:
Assurance Partners,LLC PHONE (800)563-1871 FAX
No: (785)825-5098
(A/C,No,Eat): ( )
201 E Iron Avenue E-MAIL eburch@yourassurance.com
ADDRESS:
P.O.Box 1213 INSURER(S)AFFORDING COVERAGE NAIC#
Salina KS 67402-1213INSURER A: Atlantic Specialty Insurance Company 27154
INSURED INSURER B:
Saline County Kansas INSURER C:
300 W Ash,Room 217 INSURER D:
PO Box 5040 INSURER E:
Salina KS 67402-5040 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DDIYYYY)
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 `
DAMAGE I O REN IED 100,000
CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $
_MED EXP(Any one person) $ Excluded
A 791-00-19-60-0000 07/01/2020 07/01/2021 PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
POLICY PRO- LOC _PRODUCTS-COMP/OP AGG $ 2,000,000
JECT
Employee Benefits $ 1,000,000
OTHER:
CMINEAUTOMOBILE LIABILITY (EO
aB tleDtSINGLE LIMIT $ 1,000,000
X ANY AUTO BODILY INJURY(Per person) $
A OWNED SCHEDULED 791-00-19-60-0000 07/01/2020 07/01/2021 BODILY INJURY(Per accident) $
AUTOS ONLY _ AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY (Per accident)
UMBRELLA LIAB —
OCCUR _EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ PER 0TH- $
WORKERS COMPENSATION STATUTE ER
AND EMPLOYERS'LIABILITY Y I N
ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
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 KS 67401 )[.,1-4A--''
p , ., 13U-AXYL ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD