2016-193-E DEAPR - Coulter Jewell Thames PA for TOPO survey

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DocuSign Envelope ID:06FA3CE5-ECA5-46AD-81OC-45C308AOCA40 +'1 OP ID: DR 14C0)R"' DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 03/21/2016 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 Phone:919-682-4814 NAME: Lee Hammond The Sorgi Insurance Agency Fax:919-682-4906 PHONE g19-682-4814 77777W ,No): Consultant Place Suite 102 A/C No Ext: aJC No: Durham,NC 27707 ADDRBss:Lee@sorgiinsurance.com James E.Sorgi,CIC PRODUCER COULJEW CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE NAIC# INSURED Coulter Jewell Thames, PA INSURERA:Erie Insurance Exchange 26271 PO Box 912 INSURER B:Lloyd's of London Durham, NC 27702 INSURER C: INSURER D: 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. ILTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY IYYYY MM%DD//YYYY LIMITS '.. GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 A X COMMERCIAL GENERAL LIABILITY Q470191663 11101/2015 11/01/2016 PREMISES Ea occurrence $ 2e000,000 F U7 CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 4,000,000 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY A X SCHEDULED AUTOS Q110131551 11/01/2015 11/01/2016 PROPERTY $ PROPERTY DAMAGE $ X HIREDAUTOS Q110131551 11/01/2015 11/01/2016 (Per accident) X NON-OWNEDAUTOS Q110131551 11/01/2015 11/01/2016 $ A Fx7 Uninsured Q110131551 11101/2015 11/01/2016 $ UMBRELLA LIAB I X OCCUR EACH OCCURRENCE $ 1,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 A Q350171221 11/01/2015 11/01/2016 DEDUCTIBLE Excludes $ RETENTION $ Prof Liab $ WORKERS COMPENSATION X I WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER A ANY PROPRIETOR/PARTNER/EXECUTIVEYI❑N Q955101129 11/01/2015 11/01/2016 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 B Professional Liab PGIARK02903-02 05/27/2015 05/27/2016 E Claim 1,000,000 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) RE: Orange County RFP - Topo Services CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange Co Dept.of Environment THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 p ACCORDANCE WITH THE POLICY PROVISIONS. Agriculture, Parks&Recreatio Attn: Marabeth Carr AUTHORIZED REPRESENTATIVE PO Box 8181 Hillsborough, NC 27278 auvv"JNv ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD