2016-394-E DEAPR - R. S. Jones & Associates, Inc. - land survey services, recordable plat, Pope Farm Conservation Easement

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DocuSign Envelope ID:0C943255-48A0-4AF2-858E-714AEE815BFE " LtKTIFICATE OF LIABILITY INSURANCE DATE(MM/DDlYYYY) 07/20/2016 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 CARL A.WALKER NAME; CARL A.WALKER INSURANCE AGENCY INC PHONE 919-563-0051 FAX PO BOX 553 IA/CA Lo,Est); I WC,No): 919 563-0053 EAIDNDRESS: CARLc@CARLWALKERINSURANCE.COM INSURER(S)AFFORDING COVERAGE NAIC N MEBANE NC 27302 INSURERA: ERIE INSURANCE EXCHANGE 26271 INSURED INSURER B: LLOYD'S OF LONDON 15792 R S JONES&ASSOCIATES INC INSURER C: 201 W CLAY ST INSURER D: MEBANE,NC 27302 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 AUULSUdK POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY rDAMAEACH OCCURRENCE $ 2,000,000 COMMERCIAL GENERAL LIABILITY Gt 1U HENItU PREMISES(Ea occurrence) $ 2,000,000 ■. CLAIMS-MADE HI OCCUR MED EXP(Any one person) g 5,000 A I: Q421690212 06/16/2016 06/16/2017 PERSONAL 8 ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 4,000,000 POLICY p4 JECT II LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) /ell ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED �= SCHEDULED 0061630431 AUTOS I=j' AUTOS 06/16/2016 06/16/2017 BODILY INJURY(Per accident) S • HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) g It , $ UMBRELLA MB , I $14 OCCUR EACH OCCURRENCE $ 3,000,000 A II EXCESS LIAB ■ CLAIMS-MADE Q301670212 06/16/2016 06/16/2017 AGGREGATE g 3,000,000 1 R DED RETENTION S WORKERS COMPENSATION WC STATU- NA 0TH- 5 AND EMPLOYERS'LIABILITY Y/N , I TORY LIMITS Lev ER ANY PROPRIETOFt/PARTNERIEX A OFFICER/MEMBER EXCLUDED?ECUTIVE N N/A E.L.EACH ACCIDENT $ 500,000 (Mandatory In NH) Q902100491 06/21/2016 06/21/2017 If es,desvibe under E.L.DISEASE-EA EMPLOYEE g 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 5 500,000 B PROFESSIONAL LIABILITY Limit:$2,000,000 aggregate CK409150-67926159 12/168015 12/168016 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ORANGE COUNTY ACCORDANCE WITH THE POLICY PROVISIONS. DEPT OF ENVIRONMENT,AG,PARKS AND REC PO BOX 8181 AUTHORIZED REPRESENTATIVE HILLSBOROUGH NC 27278 ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD