2016-185-E AMS - Riley Surveying, P.A. for SportsPlex fieldhouse boundary & TOPO survey

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DocuSign Envelope ID: 5547CB41-3596-4AF6-8A17-2B8F8A096240 A�CORI]►� CERTIFICATE OF LIABILITY INSURANCE DATE / 03/1111/22016 016 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 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 Greg Lopeman, CPCU NAMEACT Gre q LO eman PHONE State Farm Insurance arc o >n:919-933-7770 Arc No:919-933-7713 E-MAIL O104-B NC Hwy 54 W ADDRESS:Greg.Lo eman.NYSL Statefarm.com Carrboro, NC 27510 tNSURERS)AFFORDINGCOVERAGE NAIC# INSURER A:State Farm Fire and Casual Company 25143 INSURED RILEY SURVEYING PA INSURER B:State Farm Mutual Automobile Insurance Company 25178 STE 100B INSURER C: 3326 DURHAM CHAPEL HILL BLVD INSURER D: DURHAM NC 27707-2695 INSURER E: INSURER F 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 ADDL UBR LTR TYPE OF INSURANCE POLICY NUMBER MM1D Y EFF MWODmrY LIMITS A GENERAL LIABILITY FY-1❑ 93-65-K546-3 02120/2016 02120/2017 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY D MA E T 0 A ENT D PREMISES Ea occurrence $ 300,000 CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO- J CT 17 LOC $ B AUTOMOBILE LIABILITY ❑❑ 071 9714-D30-33 10/30/2015 10/30/2016 Ea MINED SINGLE LIMIT $ ANY AUTO ALL OWNED BODILY INJURY(Per person) $ 500,000 AUTOS X SCHEDULED AUTOS BODILY INJURY(Per accident) $ 500,000 HIRED AUTOS x NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ 100,000 A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE 93-GM-1111-1 08/1012015 08/10/2016 DED X RETENTION$ 10,000 AGGREGATE $ 1,000,000$ A WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICElMEMBER EXCLUDED? Y❑ N/A ❑ 93-BX-W682-8 02/20/2016 02/20/2017 (Mandatory in and E.L.DISEASE-EA EMPLOYE $ 1,000,000 DESCRIPTION OF OPERAT If yes,describe under E.L.DISEASE-POLICY LIMIT $ 1-1 El 1,000,000 i DESCRIPTION OF OPERATIONS r LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Certificate Holder is listed as additional insured on above referenced General Liability Policy CERTIFICATE HOLDER CANCELLATION Orange County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. Hillsborough, NC 27278 AUT IZED REPRESS ATNE 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registe d marks of ACORD 1001486 132849.6 11-15-2010