2018-027-E AMS - Riley Surveying Hwy 70 Property Survey

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DocuSign Envelope ID: F072540D- EB2B- 4CA8- AA8E- 1D36C995542C CERTIFICATE OF LIABILITY INSURANCE °01/24/2201177 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 A NAME cTGre Lo em in -_ State Farm Insurance A1c°. "r3%Ext):919- 933 - 7770 AIC No): 919-933-7713 ADDRESS: Greg. eman.NYSL Statefarm.com 104 -B NC Hwy 54 UV _ Carrboro, NC 27510 INSURERIS) AFFORDING COVERAGE NAIC # INSURER A: State Farm Fire and Casualty Company 25143 INSURED RILEY SURVEYING PA INSURER B: State Farm Mutual Automobile Insurance Compaq 25178 STE 1006 INSURER C: - 3326 DURHAM CHAPEL HILL BLVD INSURER _D: _ DURHAM NC 27707 -2695 INSURER E: _ INSURER F: COVERAGES CFRTIFICATF NIIMRFR• RFVICIrIAI Kill IMRCR- 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. [NSR LTR ADDL TYPE OF INSURANCE INSR SU R WVD POLICY NUMBER POLICY EFF MWDDI POLICY EXP MMID LIMITS A GENERALLIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR ❑Y 93- B$- KS46 -3 93- CG- Z00$ -$ 02!2012016 02120/2017 02124/2017 0712412018 EACH OCCURRENCE $ 1,001),1300 AMA GE TO RENTED PREMISES Ea occurrence $ 300,004 MED EXP (Any one person) $ 5,000 PERSONAL &ACV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO - JE T 7 LOC PRO_ DUCTS- COMPIOPAGG $ 2,000,000 S B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED X, AUTOS SCHEDULED AUTOS HIRED AUTOS X NON -OWNED AUTOS ^ I I L�J ❑ 1)71 9714- D3D -33 10/30/2016 1013012017 Ea accden SINGLE LIMIT $ BODILY INJURY (Per person) S 500,1)1)0 BODILY INJURY (Per accident ) $ 500,oDU PROPERTY DAMAGE Per accident $ 100,01)0 A IMBRELLA IJAB EXCESS LIAR_ _ X OCCUR CLAIMS -MADE 93 -GM- 9111 -1 08110/2016 08190/2017 I EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 ❑ED X RETENTION $ 10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRiFTORIPARTNERIEXECUTIVE OE�:iCF;MEMBER EXCLUDED? '� {Mandatary in NH) If yes, deschle under NIA 1 l 'mil 93- BX- W682 -8 93- CC- C931 -6 0212012016 02120/2017 ` j 0 212 012 01 7 I ". 02!2012018 WC STATU- 0TH- TORY LIMITS R E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMY 1 $ 1,01)1),1)1)0 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more space is required) Certificate Holder is listed as additional insured on above referenced General Liability Policy HOLDER Orange County PO Box 8181 Hillsborough, NC 27278 ACORD 25 (2010/0$) SHOU�OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE XPi TION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCO DAN WITH THE POLICY PROVISIONS. - REPRESENTATIVE ©1988 -2010 ACORD COTOkATION. All rights reserved. The ACORD name and logo are registered marks of ACORD `11001486 132849.6 11 -15 -2010