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Insurance Certificate
DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 06/05/2020 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 Calli Roth NAME: FAX PHONE Assurance Partners, LLC(800) 563-1871(785) 825-5098 (A/C, No): (A/C, No, Ext): E-MAIL 201 E Iron Avenuecroth@yourassurance.com ADDRESS: P.O. Box 1213 INSURER(S) AFFORDING COVERAGENAIC # SalinaKS67402-1213Admiral Insurance Company24856 INSURER A : INSURED AMCO Insurance Company19100 INSURER B : GeoCore, LLCKey Risk Insurance Company10885 INSURER C : PO Box 386 INSURER D : INSURER E : SalinaKS67402-0386 INSURER F : CL206552894 COVERAGESCERTIFICATE 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 INSRPOLICY EFFPOLICY EXP TYPE OF INSURANCELIMITS POLICY NUMBER LTR(MM/DD/YYYY)(MM/DD/YYYY) INSDWVD COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE$ DAMAGE TO RENTED 50,000 CLAIMS-MADEOCCUR$ PREMISES (Ea occurrence) ContrPol-CM/$5000 Dedt5,000 MED EXP (Any one person)$ AProfLiab-CM/$5000 DedtFEIECC153820706/01/202006/01/20211,000,000 PERSONAL & ADV INJURY$ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- 2,000,000 POLICYLOCPRODUCTS - COMP/OP AGG$ JECT Professional Liability2,000,000 $ OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY 1,000,000 $ (Ea accident) ANY AUTOBODILY INJURY (Per person)$ OWNEDSCHEDULED BACP723265307706/01/202006/01/2021 BODILY INJURY (Per accident)$ AUTOS ONLYAUTOS HIREDNON-OWNEDPROPERTY DAMAGE $ (Per accident) AUTOS ONLYAUTOS ONLY Uninsured motorist BI-1,000,000 $ single limit UMBRELLA LIAB 4,000,000 OCCUREACH OCCURRENCE$ A EXCESS LIAB FEIEXS153830706/01/202006/01/20214,000,000 CLAIMS-MADEAGGREGATE$ 0 DEDRETENTION$$ PEROTH- WORKERS COMPENSATION STATUTEER AND EMPLOYERS' LIABILITY Y / N 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT$ C N / A BNUWC015151006/01/202006/01/2021 OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS belowE.L. DISEASE - POLICY LIMIT$ Limit$100,000 Leased/Rented Equipment BACP723265307706/01/202006/01/2021Deductible$500 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) FEIECC1538206 (Contractor's Pollution, Professional Liability & GL share $1M/$2M Limit) CM=Claims Made CM Retro Dt 3/18/2002 Umbrella policy is excess of General Liability, Contractor's Pollution Liability, Professional Liability, Auto Liability and Employers Liability. This is a revised certificate and supersedes any previous certificate issued. CERTIFICATE HOLDERCANCELLATION 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 PO Box 736 AUTHORIZED REPRESENTATIVE SalinaKS67401 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 06/05/2020 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 Calli Roth NAME: FAX PHONE Assurance Partners, LLC(800) 563-1871(785) 825-5098 (A/C, No): (A/C, No, Ext): E-MAIL 201 E Iron Avenuecroth@yourassurance.com ADDRESS: P.O. Box 1213 INSURER(S) AFFORDING COVERAGENAIC # SalinaKS67402-1213Admiral Insurance Company24856 INSURER A : INSURED AMCO Insurance Company19100 INSURER B : GeoCore, LLCKey Risk Insurance Company10885 INSURER C : PO Box 386 INSURER D : INSURER E : SalinaKS67402-0386 INSURER F : CL206552894 COVERAGESCERTIFICATE 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 INSRPOLICY EFFPOLICY EXP TYPE OF INSURANCELIMITS POLICY NUMBER LTR(MM/DD/YYYY)(MM/DD/YYYY) INSDWVD COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE$ DAMAGE TO RENTED 50,000 CLAIMS-MADEOCCUR$ PREMISES (Ea occurrence) ContrPol-CM/$5000 Dedt5,000 MED EXP (Any one person)$ AProfLiab-CM/$5000 DedtYFEIECC153820706/01/202006/01/20211,000,000 PERSONAL & ADV INJURY$ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- 2,000,000 POLICYLOCPRODUCTS - COMP/OP AGG$ JECT Professional Liability2,000,000 $ OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY 1,000,000 $ (Ea accident) ANY AUTOBODILY INJURY (Per person)$ OWNEDSCHEDULED BACP723265307706/01/202006/01/2021 BODILY INJURY (Per accident)$ AUTOS ONLYAUTOS HIREDNON-OWNEDPROPERTY DAMAGE $ (Per accident) AUTOS ONLYAUTOS ONLY Uninsured motorist BI-1,000,000 $ single limit UMBRELLA LIAB 4,000,000 OCCUREACH OCCURRENCE$ A EXCESS LIAB FEIEXS153830706/01/202006/01/20214,000,000 CLAIMS-MADEAGGREGATE$ 0 DEDRETENTION$$ PEROTH- WORKERS COMPENSATION STATUTEER AND EMPLOYERS' LIABILITY Y / N 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT$ C N / A BNUWC015151006/01/202006/01/2021 OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS belowE.L. DISEASE - POLICY LIMIT$ Limit$100,000 Leased/Rented Equipment BACP723265307706/01/202006/01/2021Deductible$500 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) FEIECC1538205 (Contractor's Pollution, Professional Liability & GL share $1M/$2M Limit) CM=Claims Made CM Retro Dt 3/18/2002 Sinclair # 15019 See Endorsements: ECC5480712 ECC3190712 This is a revised certificate and supersedes any previously issued certificate. CERTIFICATE HOLDERCANCELLATION 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 P.O. Box 736 AUTHORIZED REPRESENTATIVE SalinaKS67401 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 06/05/2020 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 Calli Roth NAME: FAX PHONE Assurance Partners, LLC(800) 563-1871(785) 825-5098 (A/C, No): (A/C, No, Ext): E-MAIL 201 E Iron Avenuecroth@yourassurance.com ADDRESS: P.O. Box 1213 INSURER(S) AFFORDING COVERAGENAIC # SalinaKS67402-1213Admiral Insurance Company24856 INSURER A : INSURED AMCO Insurance Company19100 INSURER B : GeoCore, LLCKey Risk Insurance Company10885 INSURER C : PO Box 386 INSURER D : INSURER E : SalinaKS67402-0386 INSURER F : CL206552894 COVERAGESCERTIFICATE 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 INSRPOLICY EFFPOLICY EXP TYPE OF INSURANCELIMITS POLICY NUMBER LTR(MM/DD/YYYY)(MM/DD/YYYY) INSDWVD COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE$ DAMAGE TO RENTED 50,000 CLAIMS-MADEOCCUR$ PREMISES (Ea occurrence) ContrPol-CM/$5000 Dedt5,000 MED EXP (Any one person)$ AProfLiab-CM/$5000 DedtFEIECC153820706/01/202006/01/20211,000,000 PERSONAL & ADV INJURY$ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- 2,000,000 POLICYLOCPRODUCTS - COMP/OP AGG$ JECT Professional Liability2,000,000 $ OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY 1,000,000 $ (Ea accident) ANY AUTOBODILY INJURY (Per person)$ OWNEDSCHEDULED BACP723265307706/01/202006/01/2021 BODILY INJURY (Per accident)$ AUTOS ONLYAUTOS HIREDNON-OWNEDPROPERTY DAMAGE $ (Per accident) AUTOS ONLYAUTOS ONLY Uninsured motorist BI-1,000,000 $ single limit UMBRELLA LIAB 4,000,000 OCCUREACH OCCURRENCE$ A EXCESS LIAB FEIEXS153830706/01/202006/01/20214,000,000 CLAIMS-MADEAGGREGATE$ 0 DEDRETENTION$$ PEROTH- WORKERS COMPENSATION STATUTEER AND EMPLOYERS' LIABILITY Y / N 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT$ C N / A BNUWC015151006/01/202006/01/2021 OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS belowE.L. DISEASE - POLICY LIMIT$ Limit$100,000 Leased/Rented Equipment BACP723265307706/01/202006/01/2021Deductible$500 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) FEIECC1538206 (Contractor's Pollution, Professional Liability & GL share $1M/$2M Limit) CM=Claims Made CM Retro Dt 3/18/2002 Umbrella policy is excess of General Liability, Contractor's Pollution Liability, Professional Liability, Auto Liability and Employers Liability. This is a revised certificate and supersedes any previous certificate issued. CERTIFICATE HOLDERCANCELLATION 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 Department of Finance & Administration Office of City Clerk AUTHORIZED REPRESENTATIVE PO BOX 736 SalinaKS67402-0736 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD • A ® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD0B Y) 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 NAMEACT Susan Flaming Assurance Partners PHONE (800)563-1871 FAX (785)825-5098 (A/C,No.Ertl: (A/C,No): 201 E Iron Avenue E-MAIL sflaming©yourassurance.com ADDRESS: P.O.Box 1213 INSURERS)AFFORDING COVERAGE NAICC Salina KS 67402-1213INSURERA: Admiral Insurance Company 248568 INSURED INSURER B: AMCO Insurance Company 19100 GeoCore,LLC INSURER C: Granite State Insurance Company 23809c PO Box 386 INSURER D INSURER E: Salina KS 67402-0386 INSURER F: COVERAGES CERTIFICATE NUMBER: 19.20 A11 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 POUCY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DDIYYYY) (MM/DDIYYYf LIMITS X COMMERCIAL GENERALLWBIUTY EACH OCCURRENCE $ 1.000,000 ri DAMAGE TO RENTED 50,000 CLAIMS-MADE OCCUR PREMISES(Ea occurrence) S X ContrPol-CM/S5000 Dedt MED EXP(Any one person) 5 5,000 A X ProfLiab-CM/55000 Dedt FEIECC1538206 06/01/2019 06/01/2020 PERSONAL BADV INJURY $ 1.000,000 G�EINL AGGREGATE LIMIT APPUES PER: GENERAL AGGREGATE S 2.000,000 I POUCY X jEa fl LOC PRODUCTS-COMPIOPAGG_ $ 2.000,000 I OTHER' Professional Liability S 2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT s 1,000,000 (Ea evident) _ X ANY AUTO BODILY INJURY(Per person) S B OWNED SCHEDULED ACP7222653077 06/01/2019 06/01/2020 BODILY INJURY(Per accident) S _ AUTOS ONLY AUTOS _ HIRED NON S NED PROPERTY DAMAGE S X AUTOS ONLY X AUTOS ONLY (Per accident) Uninsured motorist BI- S 1,000.000 UMBRELLA UAB EA I CC. 5,000,000 X X OCCUR EACH OCCURRENCE 5 A EXCESS MB CLAIMS-MADE FEIEXS1538306 06/01/2019 06/01/2020 AGGREGATE S 5.000,000 DED X RETENTION S 0 S WORKERS COMPENSATION YIN X $TATUiE ER C Anti PROPRIETOR/PARTNER/EXECUTIVE I�'� NIA WC62498974 06/01/2019 06/01/2020 E.L.EACH ACCIDENT S 1.000,000 OFFICER/MEMBER EXCLUDED? I I (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 1.000,000 II yes.desalt.vger - 10 , 00000 elow E. DESCRIPTION OF OPERATIONS bL.DISEASE-POLICY LIMIT S , Limit 5100,000 Leased/Rented Equipment B ACP7222653077 06/01/2019 06/01/2020 Deductible 5500 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,AddlUonal Remarks Schedule,may be attached If more space Is required) FEIECC1538205(Contractor's Pollution,Professional Liability 8 GL share S1M/S2M Limit)CM=Claims Made CM Retro Dt 3/18/2002 Umbrella policy is excess of General Liability,Contractor's Pollution Liability,Professional Liability,Auto Liability and Employers Liability. 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 Department of Finance 8 Administration ACCORDANCE WITH THE POLICY PROVISIONS. Office of City Clerk PO BOX 736 AUTHORIZED REPRESENTATIVE r1 Salina KS 67402-0736 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD • `1 A CERTIFICATE OF LIABILITY INSURANCE °Aa53;.20,°"a" 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 Lindsey Stum NAME: Assurance Partners PHONE (800)563-1871 FAX (785)825-5098 AIC,No,En): (A/C.No): 201 E Iron Avenue ADDRESS: Isturn@yourassurance.com P.D.Box 1213 INSURER(S)AFFORDING COVERAGE NAIC 0 Salina KS 67402-1213INSURERA: Admiral Insurance Company 248568 INSURED INSURER B: AMCO Insurance Company 19100 GeoCore,Inc. INSURER C: Commerce and Industry Insurance Company PO Box 386 INSURER D: INSURER E: Salina KS 67402-0386 INSURER F: COVERAGES CERTIFICATE NUMBER: 18.19 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 AUDI SUER( POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMJDDIYYYY) (MMR/D/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY 1,000,000 l� EACH OCCURRENCE S — CLAIMS-MADE I OCCUR DAMAGE TO REN I ED 50.000 PREMISES(Ea occurrence) 5 X ContrPol-CM/55000 Dedt MED EXP(Any one person) 5 5.000 A X ProfLiab-CM/55000 Dedt FEIECC1538205 06/01/2018 06/01/2019 PERSONAL S. INJURY $ 1.000,000 GENt AGGREGATEUMIT APPLIES PER: GENERAL AGGREGATE _ 5 2,000,000 I� POOCY ' I JECPRO-T LOCPRODUCTS-COMP,OP AGG 5 2,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) S B — OWNED —SCHEDULED ACP7212653077 06/01/2018 06/01/2019 AUTOS ONLY AUTOS eosin,INJURY(Per accident} 5 XHIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per auidentl 5 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE 5 5.000.000 A EXCESSUAB CLAIMS-MADE FEIEXS1538305 06/01/2018 06/01/2019 AGGREGATE 5 5,000,000 DED X RETENTION S 0 S WORKERS COMPENSATION MUTE X STATUTE ER YIN 1,000,000 D ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA WC062498974 06/01/2018 06/01/2019 EL.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 II yes.describe under 1,000,000 DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT S Leased/Rented Equipment Limit 60,000 ACP7212653077 06/01/2018 06/01/2019 Deductible 500 DESCRIPTION OF OPERATIONS I LOCATORS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) FEIECC1538205(Contractor's Pollution,Professional Liability 8 GL share SIM/52M Limit)CM=Claims Made CM Retro Dt 3/18/2002 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 Department of Finance 8 Administration ACCORDANCE WITH THE POLICY PROVISIONS. Office of City Clerk PO BOX 736 AUTHORIZED REPRESENTATIVE // o Salina KS 67402-0736 9(Lidi { gt--.. I V1 (P ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 5/31/2017 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 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 Jennifer Jones NAME: FAX PHONE (800)563-1871(785)825-5098 Assurance Partners (A/C, No): (A/C, No, Ext): E-MAIL jjones@yourassurance.com 201 E Iron Avenue ADDRESS: P.O. Box 1213 INSURER(S)AFFORDINGCOVERAGENAIC# SalinaKS67402-1213 Admiral Insurance Company24856B INSURER A : INSURED AMCO Insurance Company19100 INSURER B : GeoCore, Inc. Granite State Insurance Company23809c INSURER C : PO Box 386 INSURER D : INSURER E : SalinaKS67402-0386 INSURER F : 17-18 all lines COVERAGESCERTIFICATENUMBER:REVISIONNUMBER: 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 INSURANCELIMITS POLICY NUMBER LTR(MM/DD/YYYY)(MM/DD/YYYY) INSDWVD COMMERCIAL GENERAL LIABILITY X FEIECC1538204 1,000,000 EACHOCCURRENCE$ DAMAGE TO RENTED (Contractor's Pollution, 50,000 CLAIMS-MADEOCCUR$ AX PREMISES(Eaoccurrence) XY Professional Liability, 6/1/20176/1/2018 5,000 MEDEXP(Anyoneperson)$ X ContrPol-CM/$5000 Dedt & GL share $1M/$2M Limit)1,000,000 PERSONAL&ADVINJURY$ X ProfLiab-CM/$5000 Dedt CM=Claims Made 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- X CM Retro Dt 3/18/2002 2,000,000 POLICYLOCPRODUCTS - COMP/OP AGG$ JECT $ OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $ 1,000,000 (Eaaccident) BODILYINJURY(Perperson)$ X ANY AUTO B ALLOWNEDSCHEDULED BODILYINJURY(Peraccident)$ ACP72026530776/1/20176/1/2018 X AUTOSAUTOS NON-OWNED PROPERTY DAMAGE $ XX HIRED AUTOS (Peraccident) AUTOS $ UMBRELLA LIAB XX EACHOCCURRENCE$ OCCUR 4,000,000 EXCESS LIAB CLAIMS-MADEAGGREGATE$ 4,000,000 A 6/1/2017 X FEIEXS15383046/1/2018 $ 0 DEDRETENTION$ PEROTH- WORKERS COMPENSATION X STATUTEER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACHACCIDENT$ 1,000,000 N / A OFFICER/MEMBER EXCLUDED? 6/1/2017 C WC142202256/1/2018 (Mandatory in NH) YY E.L. DISEASE - EA EMPLOYEE$ 1,000,000 Ifyes,describeunder E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS below 1,000,000 B Leased/Rented Equipment ACP72026530776/1/20176/1/2018 Limit$60,000 Deductible$500. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CG2037, ECC-548-0712, ECC-320-0712, AC7005, WC000313 City of Salina, Salina Airport Authority, USD #305, Kansas State University and Dragun Corporation CERTIFICATE HOLDERCANCELLATION certofins@salina.org 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. P.O. Box 736 Salina, KS 67402-0736 AUTHORIZED REPRESENTATIVE Debbie Walker/DWALKE ©1988-2014ACORDCORPORATION.Allrightsreserved. ACORD25(2014/01)TheACORDnameandlogoareregisteredmarksofACORD INS025(201401) DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 5/31/2017 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 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 Jennifer Jones NAME: FAX PHONE (800)563-1871(785)825-5098 Assurance Partners (A/C, No): (A/C, No, Ext): E-MAIL jjones@yourassurance.com 201 E Iron Avenue ADDRESS: P.O. Box 1213 INSURER(S)AFFORDINGCOVERAGENAIC# SalinaKS67402-1213 Admiral Insurance Company24856B INSURER A : INSURED AMCO Insurance Company19100 INSURER B : GeoCore, Inc. Granite State Insurance Company23809c INSURER C : PO Box 386 INSURER D : INSURER E : SalinaKS67402-0386 INSURER F : 17-18 all lines COVERAGESCERTIFICATENUMBER:REVISIONNUMBER: 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 INSURANCELIMITS POLICY NUMBER LTR(MM/DD/YYYY)(MM/DD/YYYY) INSDWVD COMMERCIAL GENERAL LIABILITY X FEIECC1538204 1,000,000 EACHOCCURRENCE$ DAMAGE TO RENTED (Contractor's Pollution, 50,000 CLAIMS-MADEOCCUR$ AX PREMISES(Eaoccurrence) X Professional Liability, 6/1/20176/1/2018 5,000 MEDEXP(Anyoneperson)$ X ContrPol-CM/$5000 Dedt & GL share $1M/$2M Limit)1,000,000 PERSONAL&ADVINJURY$ X ProfLiab-CM/$5000 Dedt CM=Claims Made 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- X CM Retro Dt 3/18/2002 2,000,000 POLICYLOCPRODUCTS - COMP/OP AGG$ JECT $ OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $ 1,000,000 (Eaaccident) BODILYINJURY(Perperson)$ X ANY AUTO B ALLOWNEDSCHEDULED BODILYINJURY(Peraccident)$ ACP72026530776/1/20176/1/2018 AUTOSAUTOS NON-OWNED PROPERTY DAMAGE $ XX HIRED AUTOS (Peraccident) AUTOS $ UMBRELLA LIAB XX EACHOCCURRENCE$ OCCUR 4,000,000 EXCESS LIAB CLAIMS-MADEAGGREGATE$ 4,000,000 A 6/1/2017 X FEIEXS15383046/1/2018 $ 0 DEDRETENTION$ PEROTH- WORKERS COMPENSATION X STATUTEER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACHACCIDENT$ 1,000,000 N / A OFFICER/MEMBER EXCLUDED? 6/1/2017 C WC142202256/1/2018 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ 1,000,000 Ifyes,describeunder E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS below 1,000,000 B Leased/Rented Equipment ACP72026530776/1/20176/1/2018 Limit$60,000 Deductible$500. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Sinclair # 15019 See Endorsements: ECC5480712 ECC3190712 CERTIFICATE HOLDERCANCELLATION certofins@salina.org 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. P.O. Box 736 Salina, KS 67401 AUTHORIZED REPRESENTATIVE Debbie Walker/DWALKE ©1988-2014ACORDCORPORATION.Allrightsreserved. ACORD25(2014/01)TheACORDnameandlogoareregisteredmarksofACORD INS025(201401) DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 5/31/2017 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 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 Jennifer Jones NAME: FAX PHONE (800)563-1871(785)825-5098 Assurance Partners (A/C, No): (A/C, No, Ext): E-MAIL jjones@yourassurance.com 201 E Iron Avenue ADDRESS: P.O. Box 1213 INSURER(S)AFFORDINGCOVERAGENAIC# SalinaKS67402-1213 Admiral Insurance Company24856B INSURER A : INSURED AMCO Insurance Company19100 INSURER B : GeoCore, Inc. Granite State Insurance Company23809c INSURER C : PO Box 386 INSURER D : INSURER E : SalinaKS67402-0386 INSURER F : 17-18 all lines COVERAGESCERTIFICATENUMBER:REVISIONNUMBER: 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 INSURANCELIMITS POLICY NUMBER LTR(MM/DD/YYYY)(MM/DD/YYYY) INSDWVD COMMERCIAL GENERAL LIABILITY X FEIECC1538204 1,000,000 EACHOCCURRENCE$ DAMAGE TO RENTED (Contractor's Pollution, 50,000 CLAIMS-MADEOCCUR$ AX PREMISES(Eaoccurrence) Professional Liability, 6/1/20176/1/2018 5,000 MEDEXP(Anyoneperson)$ X ContrPol-CM/$5000 Dedt & GL share $1M/$2M Limit)1,000,000 PERSONAL&ADVINJURY$ X ProfLiab-CM/$5000 Dedt CM=Claims Made 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- X CM Retro Dt 3/18/2002 2,000,000 POLICYLOCPRODUCTS - COMP/OP AGG$ JECT $ OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $ 1,000,000 (Eaaccident) BODILYINJURY(Perperson)$ X ANY AUTO B ALLOWNEDSCHEDULED BODILYINJURY(Peraccident)$ ACP72026530776/1/20176/1/2018 AUTOSAUTOS NON-OWNED PROPERTY DAMAGE $ XX HIRED AUTOS (Peraccident) AUTOS $ UMBRELLA LIAB XX EACHOCCURRENCE$ OCCUR 4,000,000 EXCESS LIAB CLAIMS-MADEAGGREGATE$ 4,000,000 A 6/1/2017 X FEIEXS15383046/1/2018 $ 0 DEDRETENTION$ PEROTH- WORKERS COMPENSATION X STATUTEER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACHACCIDENT$ 1,000,000 N / A OFFICER/MEMBER EXCLUDED? 6/1/2017 C WC142202256/1/2018 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ 1,000,000 Ifyes,describeunder E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS below 1,000,000 B Leased/Rented Equipment ACP72026530776/1/20176/1/2018 Limit$60,000 Deductible$500. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDERCANCELLATION certofins@salina.org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Salina ACCORDANCE WITH THE POLICY PROVISIONS. Department of Finance & Administration Office of City Clerk AUTHORIZED REPRESENTATIVE PO BOX 736 Salina, KS 67402-0736 Debbie Walker/DWALKE ©1988-2014ACORDCORPORATION.Allrightsreserved. ACORD25(2014/01)TheACORDnameandlogoareregisteredmarksofACORD INS025(201401) ACORQ CERTIFICATE OF LIABILITY INSURANCE ~~ F DATE (MM/DDIYYYY) 06/03/2003 S CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE DER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PRODUCER (785)825-0286 Insurors & Investors, Inc. 217 S. Santa Fe P. O. Box 1213 Salina, KS 67402-1213 INSURED GeoCore Inc P.O. Box 386 Salina, KS 67402-0386 JUN 2003 ERS AFFORDING COVERAGE A: Gul f Underwri ters Ins. Co. B: Elq)loyers Mutual Insurance c: Liberty Mutual INSURER D: INSURER E: NAIC# Co. COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN' ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I~$l: ~~~! TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY GU7119664 06/01/2003 06/01/2006 EACH OCCURRENCE $ I,OOO,OOC ~ DAMAGE TO RENTED 50,OOC X COMMERCIAL GENERAL LIABILITY . $ I CLAIMS MADE [!] OCCUR MED EXP (Anyone person) $ 5,OOC A X ContrPoll-CM CM=CLAIMS MADE PERSONAL & ADV INJURY $ I,OOO,OOC X ProfLiab-CM GENERAL AGGREGATE $ 2,OOO,OOQ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,OOO,OOQ Xl POLICY n j~8T n LOC AUTOMOBILE LIABILITY 2E48355 06/01/2003 06/01/2004 COMBINED SINGLE LIMIT - $ X ANY AUTO (Ea accidenl) I,OOO,OOQ - ALL OWNED AUTOS BODILY INJURY - $ SCHEDULED AUTOS (Per person) B - X HIRED AUTOS BODILY INJURY - $ ~ NON-OWNED AUTOS (Per accident) - PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ==1 ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ ::::J OCCUR D CLAIMS MADE AGGREGATE $ $ 1 DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC734S346163013 06/01/2003 06/01/2004 X I WC STATU- I IOJ~- EMPLOYERS' LIABILITY I,OOO,OOQ C ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ I,OOO,OOQ If yes, describe under I,OOO,OOQ SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS LATI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Salina 300 W. Ash Salina, KS 67401 @ACORDCORPORATION 1988 ACORD 25 (2001/08) ...../A.~tijt.I... .......~.IiB..,.I.III.iiIE......IIJ=......I._i8..FfI_..~.E...................................... PRODUCER SUNFLOWER INS GROUP 217 S SANTA FE POBOX 1213 SALINA 747GF INSURED GEOCORE INC PO BOX 386 SALINA KS 67402-0386 INC . ",'~""""""'"""---,-,-"""""",--""",,, . ............".....----...--...........-----...... . u.............. '..__.____......................". . DATl:(MMIDD\YV). 08-31-05 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE OMPANY A THE TRAVELERS INDEMNITY COMPANY 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. CO LTR TYPE OF INSURANCE POUCY NUMBER POUCY EFFEC11VE POUCY EXPIRATION DATE (MMIDDIYY) DATE (MMlDDIYY) UMITS GENERAL UASIUTY COMMERCIAL GENERAL LIABILITY CLAIMS MADE D OCCUR. OWNER'S & CONTRACTOR'S PROT. GENEAALAGGREGATE PRODUCTS-COMP/OP AGG. PERSONAL & ADV. INJURY EACH OCCURRENCE FIRE DAMAGE (Anyone fire) $ $ $ $ $ MED. EXPENSE (Anyone person) $ AUTOMOBILE UASIUTY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS COMBINED SINGLE LIMIT $ BODILY INJURY (Per Person) $ BODiLY INJURY (Per Accident) $ PROPERTY DAMAGE $ GARAGE UASIUTY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EACH OCCURRENCE $ AGGREGATE $ EXCESS UASIUTY UMBRELLA FORM OTHER THAN UMBRELLA FORM A WORKER'S COMPENSA nON AND EMPLOYER'S UASIUTY (UB-7751B12-1-05) 06-01-05 06-01-06 STATUTORY LIMITS EACH ACCIDENT $ -..'------ DISEASE-POLICY LIMIT $ DISEASE-EACH EMPLOYEE $ THE PROPRIETOR! PARTNERS/EXECUTIVE OFFICERS ARE: X OTHER INCL EXCL 1 000 000 1,000,000 1,000,000 DESCRIPnON OF OPERA TIONSILOCA nONSNEHICLES/RESTRICnONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CITY OF SALINA 300 WASH SALINA KS 67401 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRAnON DATE THEREOF, THE ISSUING COMPANYWlLL ENDEAVOR TO MAIL 10 DAYS WRITTEN NonCE TO THE CERnFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NonCE SHALL IMPOSE NO OBUGAnON OR UASIUTY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTA11VES. AUTHORIZED REPRESEN'U-4 .~ ............RP#PRpgBAnPHJj!iJ; ACORQM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYVYI OS/24/2005 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. I PRODUCER (800)563-1871 FAX (785)825-5098 Sunflower Insurance Group, Inc. 217 S. Santa Fe r-----~~:.------:::-..:::-;.,-.::---.;:;:;_- P.O: Box 1213 I :~- U~~~ ~ [E~ U \!i l:~ Ir\\ Sal,na, KS 67402-12q:i )lr---'------"--- "1\\ \1 INSURED GeoCore Inc ~ '-" I ; I I P.o. Box 386 li!\\! MAY ~ , 2005 .! I Sal i na, KS 6740. lh1'~ ) Jj UUi ll.::/ INSURERS AFFORDING COVERAGE INSURER A Gul f Underwriters Ins. Co. INSURER B Employers Mutual Insurance INSURER c: NCCI - Kansas INSURER D: INSURER E: NAIC# Co. COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I~~: ~9.~~ TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY GU7119664 06/01/2003 06/01/2006 EACH OCCURRENCE $ 1,000,000 I-- ~~~~~!9~RENTED X COMMERCIAL GENERAL LIABILITY $ 50,000 I-- =:J CLAIMS MADE [!] oc(:(iQl ~TRACTOR'S POLLUTION & MED EXP (Anyone person) $ 5,000 A ~ ContrPoll-CM ~ROFESSIONAL LIABILITY PERSONAL & ADV INJURY $ 1,000,000 ~ ProfLiab-CM INCLUDED IN GENERAL GENERAL AGGREGATE $ 2,000,000 I-- GEN'L AGGREGATE LIMIT APPLIES PER LIABILITY LIMITS) PRODUCTS - COMP/OP AGG $ 2,000,000 !Xl POLICY n j~T n LOC CM=CLAIMS MADE AUTOMOBILE LIABILITY 2E4835506 06/01/2005 06/01/2006 COMBINED SINGLE LIMIT - $ X ANY AUTO (Ea accident) 1,000,000 - ALL OWNED AUTOS BODILY INJURY - $ SCHEDULED AUTOS (Per person) B - X HIRED AUTOS BODILY INJURY X $ NON-OWNED AUTOS (Per accident) - - PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ==1 ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ tJ OCCUR D CLAIMS MADE AGGREGATE $ $ R DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND BINDER 06/01/2005 06/01/2006 X I T~g,n~N~ I IOJ~- EMPLOYERS' LIABILITY 1,000,000 C ANY PROPRIETOR/PARTNER/EXECUTIVE EL. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 1,000,000 ii ytlS, otllscdbe und61 1,000,000 SPECIAL PROVISIONS below EL. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER City of Sal ina 300 W. Ash Salina, KS 67401 CANCELLA TI N SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL -1L DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE R~ tI~ Roberta Blair SFLAMI ACORD 25 (2001/08) @ACORDCORPORATION 1988 .~OBll CERTIFICATE OF LIABILITY INSURANCE r DATE (MMIDDIYYYY) OS/26/2004 PRODUCER (800)563-1871 FAX (785)825-5098 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Insurors & Investors, Inc., _.___ '_""'__'_'__ ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 217 S. Santa Fe -J .~ '---'l r- :\ HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR " : '.~ \ r ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. , P. O. Box 1213 '1' 1~ Salina, KS 67402-1213 ' , :11 SURERS AFFORDING COVERAGE NAIC # ,i, INSURED GeoCore Inc I ~.'\; ',' 'iT :It URERA: Gulf Underwriters Ins. Co. I if: /.:.\ : c P.O. Box 386 I :11 I Jr SURERB: Eft1)loyers Mutual Insurance Co. , ; t ! ~. Salina, KS 67402-038~ ,.: 1_: '~ It SURER c: Liberty Mutual l...._.___.~..__.~__ '_,____.___.. ___ '" L It URER D: URER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I~~~ ~'?,~! TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE P~~!;: EXPIRATION LIMITS GENERAL LIABILITY GU7119664 06/01/2003 06/01/2006 EACH OCCURRENCE $ 1,000,00~ ~ DAMAGE TO RENTED 50,00~ X COMMERCIAL GENERAL LIABILITY $ I CLAIMS MADE [K] OCCUR CONTRACTORS POLLUTION MED EXP (Anyone person) $ 5,00~ A X ContrPoll-CM & 'ROFESSIONAL LIABILITY PERSONAL & ADV iNJURY $ 1,000,00C - X ProfLiab-CM INCLUDED IN GENEREAL GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: LIABILITY LIMIT) PRODUCTS. COMP/OP AGG $ 2,000,00C Xl POLICY n j~c?T n LOC CM = CLAIMS MADE AUTOMOBILE LIABILITY 2E4835504 06/01/2004 06/01/2005 COMBINED SINGLE LIMIT - (Ea accident) $ 1,000,000 X ANY AUTO - ALL OWNED AUTOS BODILY INJURY - (Per person) $ SCHEDULED AUTOS B - X HIRED AUTOS BODILY INJURY - (Per accident) $ ~ NON-OWNED AUTOS - PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ~ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ :=J OCCUR D CLAIMS MADE AGGREGATE $ $ ~ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC734S346163014 06/01/2004 06/01/2005 X I T~~$nJg;; I I OJb" EMPLOYERS' LIABILITY EL EACH ACCIDENT $ 1,000,000 C ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? EL DISEASE - EA EMPLOYEE $ 1,000,000 If yas, describe under -.----.---. --,--- - ---- 1,000,000 SPECIAL PROVISIONS below EL DISEASE. POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE l~IIIa\~\4-Q) EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, City of Salina BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 300 W. Ash OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Salina, KS 67401 AUTHORIZED REPRESENTATIVE R~ tlM4- Roberta Blair/ADMIN9 ACORD 25 (2001/08) ~f. 2.a1 @ACORDCORPORATION 1988 '5-C2.:&(o PRODUCER (800) 563-1871 FAX (785)825-5098 Sunflower Insurance Group, - :(nC::::::-"-- 217S S t F \ ,:.,. . an a e \' I . , , P.O. Box 1213 i i \- Sal ina, KS 67402-1213' I: INSURED GeoCore Inc P.O. Box 386 Sal i na, KS 67402..,()386,---- ...... 1 \ DATE (MMIDDIYYYY) 05/31/2006 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ACORQM CERTIFICATE OF LIABILITY INSURANCE INSURERS AFFORDING COVERAGE INSURER A Hudson Specialty Insurance INSURERB Employers Mutual Insurance INSURERC: Travelers Indemnity INSURER D INSURER E: NAIC# Co/Hu l&Com Co. COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I~~: ~9:~1 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY BINDER 06/01/2006 06/01/2007 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL L1ABI(iCO NTRACTOR'S POLLUTION & DAMAGE TO RENTED $ 50,000 I CLAIMS MADE 00 OCCUR PROFESSIONAL LIABILITY MED EXP (Anyone person) $ 5,000 A X Contr-Poll-CM INCLUDED IN GENERAL PERSONAL & ADV INJURY $ 1,000,000 X ProfLiab-CM LIABILITY LIMITS) GENERAL AGGREGATE $ 2,000,000 - 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER CM = CLAIMS MADE PRODUCTS. COMP/OP AGG $ Xl POLICY n jr8i n Ll0'I RETRO DATE: 3/18/2002 AUTOMOBILE LIABILITY 2E4835506 06/01/2006 06/01/2007 COMBINED SINGLE LIMIT - (Ea accident) $ 1,000,000 X ANY AUTO - ALL OWNED AUTOS BODILY INJURY - (Per person) $ SCHEDULED AUTOS B X HIRED AUTOS BODILY INJURY - (Per accident) $ X NON-OWNED AUTOS - - PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ =1 ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ ~ OCCUR o CLAIMS MADE AGGREGATE $ $ =1 DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND 7751Bl2106 06/01/2006 06/01/2007 X I TV;;~smI,~;, I 10J~- EMPLOYERS' LIABILITY 1,000,00C C ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICERlMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 1,000,00C If yes, describe under E.L. DISEASE - POLICY LIMIT 1,000,00C SPECIAL PROVISIONS below $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS City of Salina 300 W. Ash Salina, KS 67401 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE R~ tI~ Roberta Blair/RBLAIR ACORD 25 (2001/08) @ACORD CORPORATION 1988 ........ .---...............,...-. .-...,.....,..,..,...-.--..................-.-...-....................".."........................-.........-..................-..'--.......'...,.,............--.-.'-......... A.~iilll.$C.IR.....IIIIIA'j.<;jft:ltlSIJIRAtlSI5>< . ..........................-.--..-...-.,.,............".,...... ... ................... ..................................... .. '.................. -. - -. - - - - -. , . - , - -...........,..... ......... .oAtE(MM\DDiri).. PRODUCER SUNFLOWER INS GROUP INC 217 S SANTA FE POBOX 1213 SALINA THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE 747GF INSURED COMPANY A THE TRAVELERS INDEMNITY COMPANY COMPANY B GEOCORE INC PO BOX 386 SALINA KS 67402-038 COMPANY C COMPANY D 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. CO LTR POUCY EFFECTIVE POUCY EXPIRATION DATE (MM\DD\yy) DATE (MM\DD\YY) TYPE OF INSURANCE POUCY NUMBER GENERAL UABIUTY COMMERCIAL GENERAL LIABILITY CLAIMS MADE D OCCUR. OWNER'S & CONTRACTOR'S PROTo GENERAL AGGREGATE PRODUCTS.COMP/OP AGG. PERSONAL & ADV. INJURY EACH OCCURRENCE FIRE DAMAGE (Anyone fire) MED. EXPENSE (Anyone person) $ AUTOMOBILE UABIUTY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON.OWNED AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per Person) BODILY INJURY (Per Accident) PROPERTY DAMAGE $ GARAGE UABIUTY AUTO ONLY - EA ACCIDENT OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EACH OCCURRENCE $ AGGREGATE $ ANY AUTO EXCESS UABIUTY UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION AND A EMPLOYER'S UABIUTY THE PROPRIETORJ PARTNERS/EXECUTIVE OFFICERS ARE: OTHER 06-01-06 06-01-07 STATUTORY LIMITS EACH ACCIDENT DISEASE-POLICY LIMIT DISEASE-EACH EMPLOYEE (UB-7751B12-1-06) INCL X EXCL DESCRIPTION OF OPERATlONS/LOCATlONS/VEHICLES/RESTRICTlONS/SPECIAL ITEMS UMITS $ $ $ $ $ $ $ $ SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCEUJED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANYWlLL ENDEAVOR TO MAIL 10 DAY S WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBUGATlON OR UABIUTY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. CITY OF SALINA 300 WASH SALINA KS 67401 AUTHORIZED REPRESEN~ .~ .....Hijtiqqijpp~fip~'~~.