2016-224-E AMS - Riley Surveying, P.A. for OC Skills Development Center TOPO survey

Browse Search

DocuSign Envelope ID:8481 F610-7928-4B52-80C3-934D6886431 D AC"R" CERTIFICATE LIABILITY INSURANCE DATE(MM,Dorr" 03/11/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONftRS 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 NAME:, Grecl LO eman PHONE State Farm Insurance c o •919-933-7770 is no):919-933-7713 104-B NC Hwy 54 W E-MAIL 104-B Gre .Lo eman.NYSL Statefarm.com , Carrboro, NC 27510 INSURER S AFFORDING COVERAGE NAIC# INSURER A:State Farm Fire and Casual Com an 251 INSURED RILEY SURVEYING PA INSURER IS:State Farm Mutual Automobile Insurance Com an 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 AWL BR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICYNUMBER MM1DD MMIDD LIMITS A GENERAL LIABILITY 93-BS-K546-3 02/20/2016 02/20/2017 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY FYI M um M PREMISES Ea occurrence $ 300,000 CLAIMS-MADE a 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 I PRO LOG $ B AUTOMOBILE LIABILITY ❑❑ 071 9714-D30-33 10/30/2015 10/30/2016 Ee aBddenntSINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ 500,000 ALL AUTOS X AUTOS BODILY BODILY INJURY(Per accident) $ 500,000 HIREDAUTOS X NON-OWNED PROPERTY DAMAGE H $ AUTOS Per accident $ 100,000 A UMBRELLA LIAB X OCCUR 93-GM-1111-1 0811012015 08/10/2016 EACH OCCURRENCE $ 1,000,000 EXCESS LIAR CLAIMS-MADE DED X RETENTION$ 10,000 AGGREGATE $ 1,000,000 A WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY LI S E ANY PROPRIETOR/PARTNER/EXEC--IV- Y/N E.L.EACH ACCIDENT $ 1,000,000 OPFICEIMEMBER EXCLUDED? YD N/A 93-BX-W682-8 02/20/2016 02/20/2017 (Mandatory tyes,d In e under DISEASE-EA EMPLOYE $ 1,000,000 _DFqQR1P'r1nN OF QPFRATIQNS below F]Ryes,describe under E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,it more space Is required) Certificate Holder is listed as additional insured on above referenced General Liability Policy 1 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 RE4AT E 10 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registe d marks of ACORD 1001486 132849.6 11-15-2010