2017-125-E DEAPR - Landmark Surveying, Inc. to provide land survey services for recordable plat for Lick Creek Conservation Easement

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DocuSign Envelope ID:5714C130-71 CA-425F-9F66-AEAE54361068 ,►CORD® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) `---''' 3/17/2017 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 policiesmay 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 Glick and Mahan INC.No.Estt: (336)228-0525 Jive,Not:(336)229-0900 • 2326 S Church St Ste C E-MAIL ADDRESS:bianchd3 @rtationwide.com INSURER{S)AFFORDING COVERAGE NAIC# Burlington NC 27215 INSuRERA:Nationwide Mutual Property & 37877N INSURED INSURER a:Nationwide - Advantage S Program/ LANDMARK SURVEYING INC INSURER C:First Comp PO BOX 839 INSURER I) General Star Ins Co INSURER E: GRAHAM NC 27253-0839 INSURER F, COVERAGES CERTIFICATE NUMBER:CL1610400535 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. INSR1 ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DO/YYYY) (MMIDD+YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 • A CLAIMS-MADE X OCCUR DAMAGE T0RENTED 100,000 PREMISES(Ca occurrence) $ ACPGLK02283584929 8/27/2016 8/27/2017 MED EXP(Any one person) $ 5,000 • PERSONAL&ADV INJURY $ 1,000,000 • GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY n PRO LOC 1 PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT • {Ea accident) $ 1,000,000 A ANY AUTO BODILY INJURY(Per person) $ AUALL NED X AUTOS ACP85X2283584929 8/27/2016 8/27/2017 BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED :WNED PROPERTY DAMAGE AUT _(Per accident) • $ X UMBRELLA LIAB OCCUR •EXCESS LIAR EACH OCCURRENCE $ 2,000,000 $ CLAIMS-MADE AGGREGATE $ 2,000,000 DED (RETENTION$ ACPCIM22B3584929 8/27/2016 8/27/2017 $ WORKERS COMPENSATION _ AND EMPLOYERS'LIABILITY YIN I PER ERH •ANY PROPRiETOR/PARTNER+EXECUTIVE E.L.EACH ACCIDENT $ 1 OFFICER/MEMBER EXCLUDED? I NIA ,OOD,DOO C {Mandatory in NH) MWC0067791-03 8/27/2016 8/27/2017 EL.DISEASE-EA EMPLOYE $ 1,000,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 D Professional Liability NJA314122 12/18/2016 12/18/2017 $500,000 Limit • $5000 Deductible • DESCRIPTION OF OPERATIONS!LOCATIONS I 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 PD Box 8181 AUTHORIZED REPRESENTATIVE Hillsborough, NC 27278 , (-■k_,4__Juitg.01988-2014 ACORD CORPOR-i+ ON. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) • • • • •