Orange County NC Website
DocuSign Envelope ID: F072540D- EB2B- 4CA8- AA8E -1 D36C995542C <br />RILEY -1 OP ID: RS <br />ACORO <br />CERTIFICATE OF LIABILITY INSURANCE <br />TE (MM /DD/YYYY) <br />708/21/2017 <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, EXTEND OR ALTER THE COVERAGE AFFORDED 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 />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the 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 <br />Chas. Lunsford Sons & Assoc. <br />P.O. Box 2571 <br />CONTACT <br />NAME: Robert M. Swindell, Jr. <br />a/c° No El: ; 540 - 982 -0200 pIC, No): 540 - 344 -4096 <br />E -MAIL bswindel @chaslunsford.com <br />ADDRESS: <br />Roanoke, VA 24010 <br />Robert M. Swindell, Jr. <br />COMMERCIAL GENERAL LIABILITY <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />INSURERA:The Hanover Insurance Co <br />22292 <br />$ <br />INSURED Riley Surveying, P.A. <br />3326 Durham Chapel Hill Blvd <br />Ste B -100 Durham, INC 27707 <br />INSURER B: <br />INSURER C: <br />INSURER D: <br />$ <br />INSURER E: <br />MED EXP (Any one person) <br />$ <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <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 IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />DDL <br />INSD <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MM /DD/YYYY <br />POLICY EXP <br />MM /DD/YYYY <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ <br />CLAIMS -MADE F7 OCCUR <br />RENTED <br />PREMISES Ea occurrence <br />$ <br />MED EXP (Any one person) <br />$ <br />PERSONAL & ADV INJURY <br />$ <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ <br />PRO - <br />POLICY F7 PRO ❑ LOC <br />PRODUCTS - COMP /OP AGG <br />$ <br />$ <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />NON -OWNED <br />HIRED AUTOS AUTOS <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DIED RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />PER OTH- <br />STATUTE ER <br />ANY PROPRIETOR/PARTNER /EXECUTIVE <br />E.L. EACH ACCIDENT <br />$ <br />D? <br />OFFICER/MEMBER EXCLUDE F—] <br />N / A <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />A <br />Professional Liab <br />LHR882546206 <br />08/10/2017 <br />08/1012018 <br />Ea Claim 1,000,000 <br />Deductible $2,500 <br />Aggregate 2,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />CERTIFICATE HOLDER CANCELLATION <br />ORANGEA <br />Orange Count <br />g y <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />131 West Margaret Lane <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Hillsborough, NC 27278 <br />AUTHORIZED REPRESENTATIVE <br />40-64 I, , /L_ I <br />ACORD 25 (2014/01) <br />© 1988 -2014 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />