2016-295-E DEAPR - Landmark Surveying, Inc. - boundary survey, recordable plat for 37-acre property by S.L. Efland Heirs, LLC

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DocuSign Envelope ID: 505E90B4-7299-4C01-BDD5-5463D0215BC5 AC")?"� DATE(MM/DD/YYYY) //�L CERTIFICATE OF LIABILITY INSURANCE 6/1/2016 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). PRODUCER CONTACT Debby Blanchard NAME: Y Glick and Mahan HONE No,Ext: (336)228-0525 FAX (336)229-0900 No): (336)229-0900 2326 S Church St Ste C E-MAIL blanchd3 @nationwide.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Burlington NC 27215 INSURERA:Nationwide Mutual Property & 37877N INSURED INSURER B:Nationwide Mutual Fire Insurance 23779N LANDMARK SURVEYING INC INSURER C:First Comp PO BOX 839 INSURERD:General Star Ins Co INSURER E: GRAHAM NC 27253-0839 INSURER F: COVERAGES CERTIFICATE NUMBER:CL166100291 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 SUBR LTR TYPE OF INSURANCE POLICY NUMBER FOLIC YYYY FOLIC EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE To RENTED 100,000 A CLAIMS-MADE X OCCUR PREMISES Ea occurrence $, ACPGLK02273584929 8/27/2015 8/27/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,OOO GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑ PRO JECT ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY (CEO accidentS OMBINED INGLE LIMIT $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED AUTOS X AUTOS ACPBAK2273584929 8/27/2015 8/27/2016 BODILY INJURY(Per accident) $ X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident X UMBRELLA LAB OCCUR EACH OCCURRENCE $ 2,000,000 B EXCESS LAB CLAIMS-MADE AGGREGATE $ 2,OOO,OOO DED RETENTION$ ACPCAF2273584929 8/27/2015 8/27/2016 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N .............._STATUTE...................._ER............................................................................................. ANY PROPRIETOR/PARTNER/EXECUTIVE I E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED N/A ---- ------ C (Mandatory in NH) MWC0067791-02 8/27/2015 8/27/2016 E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 11000,000 D Professional Liability NJA314122 12/18/2015 12/18/2016 $500,000 Limit $500o Deductible DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION rshaw @orangecountync.gov SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Department of Environment, Agriculture, ACCORDANCE WITH THE POLICY PROVISIONS. Parks and Recreation PO BOX 8181 AUTHORIZED REPRESENTATIVE Hillsborough, NC 27278 _ _ ©1fI8-2014 ACORD CORPORATION. All rights reserved. I ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)