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DocuSign Envelope ID: EE9686B5- 87BA- 4CA6- A03B- 2BBFAA8BF183 <br />Ac CERTIFICATE OF LIABILITY INSURANCE °02/02/20 a <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 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 Greg LOpeman, CPGIi 'NANNEACT Greg Lopeman <br />State Farmfrlsurarlce PHet(e.Ext7:9199337770 _..__ wc,No):919 -933 -7713 <br />E -MAIL <br />104 -B NC Hwy 54 W ADDRESS: Gre .LD eman.NYSL Statefamn.cQm <br />Carrboro, NC 2 510 _ INSURERJS) AFFORDING COVERAGE NAIL 9 <br />._ _ ___ INSURER A. State Farm Fire and Casualty Company 25143 <br />INSURED RILEY SURVEYING PA INSURER B _ State Farm Mutual Automobile Insurance Company � 25175 <br />STE 100B INSURE az C : — — <br />3326 DURHAM CHAPEL HILL BLVD INSURER D; - <br />DURHAM NC 27707 -2695 INSURER E: --- <br />_._ $ NSURER F : <br />COVERAGES CERTIFICATF NIiMRFR• Pr- viclnm NIIu ni=R. <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 />_.. <br />1NSR 'ADDLiSUBR POLICY EFF " P[11LICY EXP LIMITS <br />LTR TYPE OF INSURANCE POLICY NUMBER MMIO07YYY1( kIM1DDlYYYY <br />A <br />GENERAL <br />X <br />LIABILn'Y <br />COMMERCIAL, GENERAL LIABILITY <br />� <br />CLAIMS -MADE ' - 1 OCCUR <br />_ <br />Y <br />�`� <br />'I I <br />LJ <br />93 G�i Z{11T-$ <br />93-CG-ZOOS-8 <br />D2)ZOI2Qt$ <br />0212012017 <br />I <br />D$I2UI20 tS <br />D2f20f2ti18 <br />EACH OCCURRENCE <br />DAMAGE $ (Ea oc <br />PREMISES nccurrence <br />$ 7 >QUfl.QQCI <br />$ 3[DO.UUO <br />ME_D EXP (Any one as s n) <br />$ 5,000 <br />PERSONAL & ADV INJURY <br />GENERALAGGREGATE <br />S 1,000,000 <br />S 2000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />X POLICY PRO- LOC <br />PRODUCTS - COMPIOP AGG <br />S _ 2,DOO,000 <br />S <br />B <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />AUTOS <br />HIRED AUTOS X NON -OWNED <br />_ AUTOS <br />❑ <br />❑ <br />071 97'14- D30 -33 <br />10/3012017 <br />1013012fl18 <br />1 <br />Ee acV d.D SINGLE LIMIT <br />S 50fl,DQa <br />BODILY INJURY (Pat pemen) <br />J <br />BODILY INJURY IPeracelden[ ) <br />- PR©PERTY DAMAGE <br />Par accident <br />1 <br />$ 500,006 <br />_ <br />$ 160,600 <br />$ <br />rA <br />UMBRELLA LIAR }( OCC QR <br />EXCESS LIAR J CLAIMS -MADE <br />DED i X RETENTIONS 10,000 <br />I <br />93- GM- 1111 -1 <br />08110120'17 <br />0811D1�2018 <br />EACH OCCURRENCE <br />$ 1,000,000 <br />$ 1,000,000 <br />AGGREGATE <br />! <br />. -. -.__ <br />S <br />W ORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETORIPARTNERJFXFCUTIVE M <br />I OFFICE'MEMSER EXCLUDED'? <br />1 (Mandatory 1. NH) <br />1 If yes, describe under <br />r3r1;CR1PT1C1N OF OFF RATIONS beIM <br />NIA <br />� <br />93- CV- L457 -5 <br />93- CC- C931 -6 <br />0212012018 <br />j <br />02/20/2017 <br />02!2012019 <br />0212012018 <br />I WC STATU- OTH- <br />- -'- <br />1,Qflfl;Dflfl <br />E.L. EACH ACCIDENT <br />— - - ° <br />E.L. DISEASE - EA EMPLOYE <br />E "L" ©ESEASE • POLICY L1M17 <br />_5 <br />S 1,000,000 <br />S 1,060,0DiJ <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) <br />CERTIFICATE HOLDER CANCELLATION <br />Orange County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />PO Box 8181 ACCOR NCE WITH TH POLICY PROVISIONS. <br />Hillsborough, NC 27278 _.._ -.J.11 ---------- <br />11 01988 -2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 1001486 132849 -6 11 -15 -2010 <br />