2016-199-E AMS - Riley Surveying, P.A. for surveying services for EAC project according to proposal dated 3-9-2016

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DocuSign Envelope ID:01D42433-88CA-4F86-A8BE-A18CF97E030D AC®R®® DATE(MMIDD/YYYY) CERTIFICATE F LIABILITY ILI INSURANCE 03/1112016 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(les)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 NAA°f"neacT Gre Lo eman State Farm Insurance PHONE .919-933-7770 X No:919-933- 713 104-B NC Hwy 54 W ADDRESS:Gre .Lo eman.NYSI Statefarm.com LEEI) Carrboro, NC 27510 INSURERS AFFORDING COVERAGE NAIC# INSURER A:State Farm Fire and Casual Company 261 INSURED RILEY SURVEYING PA INSURERS:State Farm Mutual Automobile Insurance Company 26178 STE 1008 INSURERC: 3326 DURHAM CHAPEL HILL BLVD INSURER D: DURHAM NC 27707-2695 INSURER E: INSURER P: 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 AWL POLICY NUMBER MIOLDDY EFF MIONUDD EXP LIMITS A GENERAL LIABILITY YM 93-B5-K546-3 02120/2016 02120/2017 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY M 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 LIMITAPPLIESPER: PRODUCTS-COMP/OPAGO $ 2,000,000 Jr X POLICY LOC B AUTOMOBILE LIABILITY 071 9714-D30-33 10/30/2015 10/30!2016 (CO�M Nden SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per persm) $ 500,000 ALL OWNED SCHEDULED AUTOS X AUTOS BODILY INJURY(Peraccident) $ 500,000 HIRED AUTOS X NON-0WNED PROPERTYDAMAGE AUTOS Peracddent S 100,000 $ /� UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 1,000,000 EXCESS LIAR 93-GM-1111-1 06/10/2015 08/10/2016 ER CLAIMS-MADE AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 A WORKERS COMPENSATION S AND EMPLOYERS'LIABILITY WO STATUS T ANY PROPRIETOR/PARTNEf2/EXECUTiVE YIN E.L.EACH ACCIDENT $ 1,000,000 OFFICElMEMBER EXCLUDED? N/A 93-BX-W682-8 02/20/2016 02/20/2017 (Mandatory be and E.L.DISEASE-EA EMPLOYE If yes,desaibeunder $ 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 El E DESCRIPTION OF OPERATIONS I 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 PO Box 8181 ACCORDANCEIWITHTH POLCYPROVISIONS.NOTICE WILL BE DELIVERED IN Hillsborough, NC 27278 AUTH IZED REPRESE ATIVE I � f c 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