2015-223-E DEAPR - MdM Historial Consultants for Agricultural History Research Project $4,000

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DocuSign Envelope ID: DA2607DE -OE33- 467E- B8B3- lCO0123BE8A9 OP ID: C1 ACORO CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 10/2312014 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). PRODUCER Lee -Moore Insurance Agency Inc P.O. BOX 667 West End, NC 27376 Christopher Stephenson CONTACT PHONE FAX A/C No Ext : A/C No): E -MAIL ADDRESS: PRODUCER MDMHI -1 CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # INSURED MDM Historical Consultants, In INSURER A: Hartford Insurance 14397 Cynthia de Miranda PO Box 1399 INSURER B X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F—I OCCUR INSURER C : Durham, NC 27705 INSURER D: 09/25/2015 DAMAGET R EN TED PREMISES Ea occurrence INSURER E: MED EXP (Any one person) $ 10,00 INSURER F: $ 1,000,00 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. INSR LTR TYPE OF INSURANCE DDL UBR POLICY NUMBER MM POLICY EFF DDtYYYY MMLDDY EXP /YYYY LIMITS Christopher Stephenson GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F—I OCCUR X 22SBMVE4769 0912512014 09/25/2015 DAMAGET R EN TED PREMISES Ea occurrence $ 300,00 MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LI MIT APPLI ES PER: PRODUCTS - COMP /OPAGG $ 2,000,00 POLICY 7 PE OT LOC Emp Ben. $ 5,00 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 100,00 ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY I NJU RY (Per accident) $ X SCHEDULED AUTOS HIREDAUTOS 22SBMVE4769 0912512014 09/25/2015 PROPERTY DAMAGE (PER ACCIDENT) $ X NON -OWNEDAUTOS 22SBMVE4769 09125/2014 09/25/2015 $ UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DEDUCTIBLE $ $ RETENTION $ WORKERS COMPENSATION WC STATU- OTH- ANDEMPLOYERS' LIABILITY Y/ N TORY LIMITS ER E.L. EACH ACCIDENT $ ANY PROPRIETOR /PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N /A E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, descdbe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS f VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Natural and Cultural Resources Division, Support Services Division 306A Revere Rd. Hillsborough, NC 27278 CERTIFICATE HOLDER CANCELLATION ©1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Natural and Cultural Resources THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Division, Support Services Division AUTHORIZED REPRESENTATIVE 306A Revere Rd. Christopher Stephenson Hillsborough, NC 27278 ©1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD