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DocuSign Envelope ID: 342F21BB- E144- 42B3- 84AD- F2806437E58D <br />AC "R" 0 CERTIFICATE OF LIABILITY INSURANCE DATE <br />01/24/2017Y1 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTENT? OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the <br />terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />Certificate holder in lieu of such endorsement(s). <br />PRODUCER CONTACT <br />Greg Lopeman, CPCU _NAME: Greq LoQeman.. . <br />State Farm Insurance _(AL°" . Ext): 919 -933- -7770 - .. _ [AAic, No)._919- 93-3- -7713 <br />E -MAIL <br />104 -B NC Hwy 54 W ADDRESS: Greq.LoQeman_NYSL @Statefarm.com <br />Carrboro, NC 27510 INSURER[$) AFFORDING COVERAGE j NAIC # <br />- - <br />INSURER A: State Farm Fire and Casualty Company 25143 _ <br />INSURED RILEY SURVEYING PA - INSURER IS: State Farrn_Mutuai Automoble Insurance Corqp3ny 2I <br />STE 100B _.INSURER C: <br />3326 DURHAM CHAPEL HILL BLVD INSURER D: <br />DURHAM NC 27707 -2695 INSURERS;._ __.. <br />COVERAGES CFRTIFIC-'ATF Nl1MRFR• RFVICInnI KIl IMPr:0- <br />THIS iS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 13 SUBJECT TO ALL THE TERMS, <br />EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR - - ADDLSUBR POLICY EFF POLICY EXP <br />LTR TYPE OF INSURANCE I yyVp I POLICY NUMBER MWDDIYYYY MNVDp! LIMITS <br />GENERAL LIABILITY <br />A _ Y <br />93- B5- 1(546 -3 <br />0212012016 <br />0712072017 <br />EACH OCCURRENCE s 1,DDD,oD4 <br />COMMERCIAL GENERAL LIABILITY <br />93- CG- ZO05 -8 <br />02/2012017 <br />02/20/2018 <br />PREMISES (Ea olccu D nce} 5 300,004 <br />i <br />CLAIMS -MADE � " I OCCUR <br />MED EXP (Any one person) 5 5,000 <br />PERSONAL &ADV INJURY 5 1,000,000 <br />_ <br />GENERAL AGGREGATE S 2,000,000 <br />GEN'LAGGREGATE LIMIT APPLIES PER; <br />PRO DUCTS - COMP/OP AGG $ 2,000,000 <br />X PRO - <br />I 7 <br />_ <br />POLICY IF T LOC <br />$ <br />B <br />AUTOMOBILE <br />LIABILITY <br />❑ ❑ 071 9714- D30 -33 <br />'1013012016 <br />1013012017 COMDINEQ 51NGLE LIMIT $ <br />ANY AUTO <br />BODILY INJURY (Per person) l Y 500,000 <br />_._ <br />ALL OWNED x SCHEDULE0 <br />AUTOS � AUTOS <br />BOCiLY INJURY {Per accident) S 500,000 <br />j NON -OWNED <br />HIRFDAUTOS <br />_ <br />PROPERTY DAMAGE - - -- <br />Per accident J� S 100,000 <br />�X <br />A <br />UMBRELLA LIAR X OCCUR <br />�,❑ <br />93 -GM- 1111 -1 <br />0811012016 <br />EACH OCCURRENCE 1,000,000 S <br />0811012017. , - - -- 0,0 . <br />EXCESS LIAB _.- - CLAIMS -MADEI <br />AGGREGATE, $ 1,000,000 <br />DEC X i RETFNTI( 5 1orw)o <br />I <br />I$ <br />A <br />WORKERS COMPENSATION <br />WC STATU- OTH- <br />' AND EMPLOYERS' LIABILITY YIN <br />4 <br />TDRY LIMITS ER _I <br />ANY PROPRIFTORIPARTNERIEXECUTIVE <br />OFFICEIMEMBER EXCLUDED? � <br />! <br />NIA <br />93- BX- W682 -8 <br />02/2012016 02/20/2017 <br />E.L. EACH ACCIDENT $ 1,000,000 <br />-- - - <br />1,ODD,DDO <br />If yes, describe uHder <br />y <br />93- CC- C931 -6 <br />02120/2017 02/20/2018 <br />- <br />T <br />E. L. DISEASE -POLICY LOMIr��$ <br />S 1,000,400 <br />DI❑ <br />!, <br />DESCRIPTION OF OPERATIONS 1 LOCATIONS r VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) <br />Certificate Hoider is listed as additional insured on above referenced General Liability Policy <br />TE HOLDER <br />Orange County <br />PO Box 8181 <br />Hillsborough, NC 27278 <br />ACORD 25 (2010105) <br />SHOUL�Y OF THE ABOVE DESCRIBED POLICIES 13E CANCELLED BEFORE <br />THE XPIR TION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. __ <br />REPRESENTATIVE <br />O 1988 -2010 ACORD CO 0 'PION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD 1 Gx1486 132849.6 11 -15 -2010 <br />