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DocuSign Envelope ID:8FF17345-EO70-4A5A-BO69-2974E2219CD3
<br /> 1 =TE HYYYYl CERTIFICATE OF LIABILITY INSURANCE (015
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER, OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br /> CERTIFICATE DRIES 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: If the certificate holder is an ADDITIONAL 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 lieu of such endlOrsement(s).
<br /> PRODUCER Greg Lo�aemrl, CPCU CONTACT
<br /> gtan�E: reg Lopeunan ---.. _.-
<br /> PHONE FAx
<br /> State Farm ArISUl2nCe c No,Ext),919-933 7770 __ �A)C,hN1:919-933-7713... ..
<br /> E-MAIL
<br /> 104-B NC Hwy 4 W ADDRess:_Greg Lolaemar,NYSL @Statefarrn.c®m
<br /> ` NAIC#
<br /> C rCbQr13, NC 27510 INSURER(S)AFFORDING COVERAGE INSURER A:State Farm Fire and_Casualt-,.Com an .. 2.5143
<br /> INSURED INstIRER B:State Farm Mutual Automobile Insurance Company 251.78:......-.._
<br /> RILEY SURVEYING PA _ -
<br /> STE 11OOB INSURERC:
<br /> 3326 DURHAM, CHAPEL HILL BLVD INSURER D:
<br /> DURHAM PAC 277017-2695 INSURER E:
<br /> INSURER F
<br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 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 CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> ..., AWL SUBR POLICY EF— F POO&E#P .............. --_ _..._._—.
<br /> INTR TYPE OF INSURANCE LIMITS
<br /> LTR IN R POLICY NUMBER MMtDOIYYYY. MMIDD1YYYY
<br /> GENERAL LIABILITY ,"�-B x-64546- 02120f2'015 OZlZOI'2016 DITMAGGE TCF DENTED $-, _._._...._ 1 3047,Q00
<br /> A
<br /> ._ COMMERCIAL GENERAL LIABILITY r?F2L"Pr�l'SES(Ea_Iaccur7ence)_
<br /> CLAIMS-MADE ersorr)OCCUR MED EXP(Any oa�e P $. 5,000
<br /> -
<br /> PIERSONAL&ADVINIJURY $. 1,000,000
<br /> _.— _.. _
<br /> j { GENERAL AGGREGATE $ 2,000 000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: ? i:. PRODUCTS-COMP/OP AGG $ ., 2„000,000
<br /> I ..... ...._.
<br /> ' `JC I POLICY 9-- l � LOO $
<br /> COMBINED SINGLE IJMI1
<br /> B AUTOMOBILE LIABILITY 071 9714-D30-33 10130/2015 04/30/2016 (Ea accrdent) ...... $ -__ _.._._._
<br /> 7 ANY AUTO 'BODILY INJURY IP�erperson) $ 500,000
<br /> 'ALL OWNED .. SCHEDULED BODILY INJURY(Per accodent) � 500,000
<br /> AUTOS " AUTOS I .._._
<br /> PROPERTY DAMAGE ..,,,,
<br /> NON OWN Peraccide(nt). $ 1..00O
<br /> t9GREIJA'U'rOS AUTOS ' - ... �.. -
<br /> i
<br /> EXCESS LIAR 93-GM-1111-1 08110/2015 00110/2016 EACH OCCi RRENCL s 1,00 ,800
<br /> A ...._....UMBRELLA.LIAR >4 OCCUR �❑ I� AGGREGATB $ 1,000,000
<br /> CLAIMS MADE
<br /> DIED RETENTION$ 10,000 $VVC
<br /> A ANY PROPRIET)RrPARTNE NIA 93-B7G R�a72-$ 02d20ITQ15 O2f20P2016 T CID
<br /> 'WORKERS COMPENSATION
<br /> AND EMPLOYERS'LIABILITY
<br /> RfEXEDUTI'4FE YIN E.L.EACH ACCIDENT $ 1,000,000
<br /> 4?F,�•iCEfMEM®CR EXCI_UOEO? fl - ..
<br /> (Mandatary in NH) j_-E.L.DISEASE-EA EMIRLO'YE- $ 1,000 000
<br /> If yes,describe under I ' 1,OQO,QOO
<br /> p E.L.DISEASE-POLVCY LIMIT
<br /> 1I
<br /> DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required)
<br /> Certificate Holder is fisted as additional insured on above referenced General Liability Policy
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> Orange C�rtJflt SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> County THE EXPI T' N DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> PO 1OX$�7 ACCORDA CE TH THE POLICY PROVISIONS.
<br /> Hillsborough, NC 27278 AUTHORIZED R RESFNTATIUE m A
<br /> 9dlively0 arangiecountync- e��r 1,,
<br /> I aq
<br /> 07 1988-2010 ACORD CORD TION. All rights reserved.
<br /> ACORD 25(2'010!'06) The ACORD name and logo are registered marls of ACORD 10011486 132849.6 11-15-2010
<br />
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