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DocuSign Envelope ID:2D2FC031-D998-499D-8152-4DOC1 B8B6D3D
<br /> AM,►°° CERTIFICATE OF LUAr-ALIT` INSU j,,A NCE ©E(
<br /> f"// ice' HATE(MiUVDDIYYYY)
<br /> Ir.../ 412017
<br /> 1 THIS CERTIFICATE IS ISSUED AS A ",TATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDEIP BY THE POLICIES
<br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> terms and T; If the
<br /> conditions of the holder
<br /> certain DIi IONAL INSUr"'ED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the
<br /> IMPORTANT; If t certificate holder is an ADDITIONAL
<br /> policy, policies may require an endorsement. A statement on this certificate does not confer rights to the
<br /> certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CPCU � Greg Logeman
<br /> FAX Farm Insurance -
<br /> PHONE E 919-933 7770 Ac,N©y 919-933-7713
<br /> 104-B NC Hwy 54 W
<br /> E-MAIL
<br /> NSURER(S)}AFFORDING COVERAGE— — _
<br /> " I —CBrrborO NC 27510
<br /> INSURER SA�Seate Farm Fire and Casualty COVERAGE NA
<br /> 25143
<br /> INSURED RILEY SURVEYING PA INSURER B State Farm Mutual Automoble Insurance Company! 25178
<br /> STE 1008 INSURER C r
<br /> 3326 DURHAM CHAPEL HILL BLVD INSURER D;
<br /> DURHAM NC 27707-2695 INSURER E
<br /> ,._... .,.... _.. ..... INSURER F _-_-�-
<br /> COVERAGES CERTIFICATE NUMBER; REVISION °IUMER:
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LASTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> INDICATED. NOTVVITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, -1HE INSURANCE AFFORDED BY THE POLICIES DESCRIED HEREIN IS SUBJECT TO ALL THE TERMS,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. i
<br /> INSR °.... ..............- _... ...-, ______ WiDDLrSUBRI°.. ........_._.-- -.. POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER LAMM/IDIYYYYLJMMIOD/YYYY LIMITS
<br /> A GENERAL LIABILITY Y �� 93-B5-1(.546-3 0212012016 02/20/2017 EACHUCCURRFNCE 0 1,000000
<br /> X COMMERCIAL GENERAL LIABILITY DAMAGE TtTRENTEb
<br /> 93-CG-2005-8 02120/2017 02/20/2018 PREMISES(Ea occurrence) $ 300 000
<br /> CLAIMS-MADE rx OCCUR � MED EXP Any one person) g. 5,000
<br /> PERSONAL a ADV lNUURY 1,000,000 I
<br /> GE'NERALAGGREGATE 2,000,000 I
<br /> DEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP ADC $ 2,000,000
<br /> X POLICY
<br /> PRO LOC
<br /> I
<br /> J TY
<br /> B AUTOMOBILE LIABILITY 071 9714-D30-33 10/30/2016 10/30/2017 (E BIKED SINGLE LIMIT
<br /> ANY AUTO BODILY INJURY(Per Person} d; 500,000
<br /> ALL OWNED X. SCHEDULED j BODILY INJURY)Per accident)
<br /> AUTOS AUTOS :b 500,000
<br /> \„. N N NON-OWNED PROPERTY DAMAGE
<br /> HIRED AUTOS AUTOS .(Per y 1 0 0,000
<br /> _. ..
<br /> UMBRELLA LAB Eli E I
<br /> A X De,UUR u` Gf 93-GM-1111-1 0er1012016 08r10r2017 I EACH OCCURRENCE 0 1,00D o00
<br /> EXCESS LIAB AGGREGATE $ 1„000,000
<br /> 1 DEC X, RETENTION'$ CLAIMS-MADE 10,000' --- .. .... .... ._._._ __.,_ ...
<br /> _...___...__. J_
<br /> i
<br /> A WORKERS COMPENSATION WC START- 0TH- -
<br /> AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER _
<br /> ANY PROPRIETOR/PAR1°NER/EXECUTIVE � E°L.EACH ACCIDENT I $ 1,000,000
<br /> OFFICE/MEMBER EXCLUDED? L " I..NIA 93-BX-W682-8 02120120/6 02/20/2017 - -- .° .........._
<br /> (Mandatory in NH) ---° E.L.DISEASE°EA EMPLOYEE) $ 1,000 000
<br /> If yes,descnhe under 93-CC-C931-6 02/20/2017 ' 02/20/2018 1— —
<br /> DESCRIPTION OFOPFRATIONS below E .DISEASE-POLICY LIMIT L$ 1,000,000
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,it more space is required)
<br /> Certificate Holder is listed as additional insured on above referenced General Liability Policy
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> prang County SHOUL' , :Y OF THE ABOVE DESCRIBED POLICIES BE.CANCELLED BEFORE
<br /> THE O XPI'p,TION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> PO Box 8181 ACCO•DAN WITH THE POLICY PROVISIONS.
<br /> Hillsborough, , C 27278 AUTHORIZE1 REPRESENTATIVE �� _--. �/r/
<br /> (( '`C . '
<br /> ACORD 25 2010105 The ACORD ©1988-2010 ACOR•CO Ol^" -TION. All rights reserved.
<br /> 6 ) e ORD name and logo are registered marks of ACORD \ 11001486 132849.6 11-15-2010
<br />
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