2017-181-E AMS - Riley Surveying, P.A. for surveying services for old courthouse and jail

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DocuSign Envelope ID:8A89E5D4-F8B5-49AF-8D96-4FABAAC6420A A�CORI]►* CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYVY) 03/11/2016 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 Greg Lopeman, CPCU CONTACT Greg Lopeman PHONE State Farm Insurance (Arc.No.Ext):919-933-7770 FAX No):919-933-7713 E-MAIL 104-B NC Hwy 54 W ADDRESS:Greg.Lopeman.NYSL @Statefarm.com 1:41 Carrboro, NC 27510 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:State Farm Fire and Casualty Company 25143 _ INSURED RILEY SURVEYING PA INSURER B:State Farm Mutual Automobile Insurance Company 25178 STE 100B INSURER C: 3326 DURHAM CHAPEL HILL BLVD INSURERD: DURHAM NC 27707-2695 INSURERE: — — 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 -ADDL SUBR LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (POLICY r D/YYYY) (M POLICY LIMITS A GENERAL LIABILITY y 93-B5-K546-3 02/20/2016 02/20/2017 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(Ea occurrence) $ 300,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO _ JECT LOC $ B AUTOMOBILE LIABILITY 071 9714-D30-33 10/30/2015 10/30/2016 COMBINED SINGLE LIMIT (Eaacdent) $ ANY AUTO BODILY INJURY(Per person) $ 500,000 ALL OWNED SCHEDULED AUTOS X AUTOS BODILY INJURY(Per accident) $ 500,000 HIRED AUTOS x NON AUTO-OWNED S PROPERTY DAMAGE (Per accident) $ 100,000 $ A UMBRELLA LIAB X OCCUR 93-GM-1111-1 08/10/2015 08/10/2016 EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 $ A WORKERS COMPENSATION WC STATU- 0TH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICE/MEMBER EXCLUDED? Y N/A 93-BX-W682-8 02/20/2016 02/20/2017 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS 1 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 EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. Hillsborough, NC 27278 AUT TIZED REPRESE ATIVE - I M44 . 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