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11111.36V • 1• YT V1
<br /> A 46V I. Vl 1
<br /> A °C R°F CERTIFICATE OF LIABILITY INSURANCE DATE INIAIDDWYYY'
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
<br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER,
<br /> IMPORTANT: It the certificate holder is an AOOTIONAL INSURED,the policy(Ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the
<br /> terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the
<br /> certificate holder In Neu of such endorsement(s).
<br /> PRODUCER Greg Lopeman,CPCU NNAAmE:CT Greq L
<br /> UCE opeman _. .
<br /> State Farm Insurance PHONE — _ FIAT —
<br /> IA2.NaErtt 9iB�3777D Wc,Nvk91&9337713
<br /> 104-B NC Hwy 54 W mm ss:Greglopeman.NYSLAStatefarm=com _ _____ —_
<br /> Carrboro,NC 27510 INSURER'S)AFFORDING COVERAGE IIAIC•
<br /> _ _..— , ..—NLSUBER A-Slate F9rm Ffe_and ltaraitY C.OmPonY MKI
<br /> 'NsuRED RILEY SURVEYING PA — — — — !NSUpsa B:Statepami Mutual Autorr bil ineurance Company__ ._ova_
<br /> STE 1008 missal cc .. .— -- -- ---— --- --
<br /> 3326 DURHAM CHAPEL HILL BLVD INSURER D:— —, - — •—° ---
<br /> DURHAM NG 27707-2695 Rlsullet<E_- _.
<br /> --
<br /> INSURER INSURER F: . --
<br /> • ' •
<br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> INDICATED.NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br /> EXCLUSIONS AND CONDmoelS OF SUCH PODU[C;IES-LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> I.gR;TYPE OF INSURANCE NW1^_ POUCYNUMaER IMMIDOWYYYI IYWOD/YYYTI LENTS
<br /> A GENERAL LIABILnY r1111 I 93-BR-V954-8 08/10/2011 08/10/2012 EACH OCCURRENCE t 1,000,000
<br /> X COMMERCIAL GENERAL LIABILITY
<br /> -DAMAGE
<br /> LREMI ESI RENTED —
<br /> 93-67($844•.tS _&10.2012 OBI 'PREN5E51Ee ocurr��ce1.....$ 900,000
<br /> _. ..J CLAIMS-MADE I X I OCCUR MED EX?IA^Y one pemanl S 5,000
<br /> • PERSONAL 6 ADV INJURY S 1,000,000
<br /> GENERAL AGGREGATE S 2,000,000
<br /> GErrL AGGREGATE LIMIT APPLIES PER .PRODUCTS•CONPIOP AGG t - 2,000,000
<br /> I 11 LOC S 1
<br /> COMBINED SINGLE LIMIT
<br /> 6 AUTOMOBILE LIAGAJIY Oil 0719714-D30-33 tIY30f2011 10I9W�.112 1POMBIN_SIN —L. ._—..
<br /> _ I ANY AUTO {I—,I BODLY INJURY(Pei Pool 1 s—.. 5°0,000
<br /> ALL OWNED x I SCHEDULED I PROPERTY BODILY INJURY(Rs,=KURT,5 500,000
<br /> . _AUTOS —,AUTOS PROPERTY MI
<br /> DAMAGE .. .--...
<br /> _._ /TIRED AUTOS AUTOS ED _per 1 _S_ 100,0__
<br /> I S
<br /> A UMBRELLA UAa I X OCCUR flu 93-GM-1111.1 08/10/2011 0811012013 EACH UC(2URRENLE I S___ - 110°0•°00
<br /> EXCESS LIMB .L— M
<br /> . CLMS-IIADE AGGREGATE _ S _ 1,090.000.
<br /> iDED I X I RETENTION 1 10,000 I ,S
<br /> A AON EMPLOYERS'YENS' IIJT 93�-W14-6 08/10/2011 :08/1012012 _X i IOORRYSUwTS I DTI-— —
<br /> Ar0 FJIpLOYEri9'IJANrLRY ..
<br /> ANY PROPRIETORIPARTNER/EXECUTWE Y+8/ E.L.EACH ACCIDENT S 100,0
<br /> caTIGEmBiBEREXCLUD®7 © NIA I r 91•-9)($817-2 08/1012012 06I10/2013 �...— 1t30.t100
<br /> tW, ry a•erl I 1 EL.DISEASE-EA EMPLOYEES ___ _
<br /> rte. r.— _ . .. ..
<br /> NDE,CCRWT1rINnFnPFRATNU'IShNpv I E.L DISEASE-POLICY LIMT I S 500..0
<br /> 0
<br /> l i
<br /> DESCRIPTION OF OPERATTORS 1 LOCATONS I V9NCI PS Wroth ACORO 1el,-_ __,Reme1I,A Sc,.ma.((®yt apace Is,.q,ymi)
<br /> SUrveyOrS
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOIA.D THE ABOVE DESCR BED POLICIES BE CANCELLED BEFORE
<br /> Orange County The EX DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Attn:Jeff Thompson ACC.-• . WITH THE POLICY PROVISIONS.
<br /> PO BOX 8181 Alf! O ED -+_-, ATREE ;
<br /> Hillsborough,NC 27278 / 2
<br /> e 1988-2010 ACORD s ,.ORATION. All rights reserved.
<br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1001486 132849.6 11-15-2010
<br />
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