2018-688-E DEAPR - Landmark surveying topo

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DocuSign Envelope ID: EEE8E57E-302D-415C-9356-8F5DD82FB3CA a CERTIFICATE OF LIABILITY INSURANCE DATE IM6/20 1611 l26 8 ��- 1e 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 pollcy(les)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 yE. - Debby Blanchard Glick and Mahan PHDNE (336)228-0525 TF—AX {9363x29-0900 AX L01: 2326 S Church St Ste C E4611AIL blanchd3@nationwide.corn ADDRESS: INSURERISI AFFORDING COVERAGE NAIC 9 Burlington NC 27215 INSURER A:Nationwide Mutual Propert y & Casualty C 37877" INSURED INSURER B:Nationwide Mutual Fire insurance Compar 23779N Landmark Surveying Inc INSURER C:First Comp PO Box 839 INSURER O:General Star Irks Co INSURER E: Graham NC 27253-0839 INSURER F: COVERAGES CERTIFICATE NUMBER:CL18101601800 REVISION NUMBER: 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. INSR TYPE OF INSURANCE ADeL LTR IY D POLICYNUMBER MMIODlYEFF lWDDYE� LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE ❑X OCCUR PREMISES T ENT 100,000 PREMISES Ea occurrence $ ACPGLX02203584929 8127/2018 8/2712019 MEO EXP(Any one Person) S 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERA.AGGREGATE $ 2,000,000 X POLICY n PR 7 LOC PRODUCTS-COMPIOP AGG $ 2,000,000 OTHER: $ ALROMOBiLELIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident A ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED ACpftU2203564929 8/27/2016 8/27/2019 BODILY INJURY IParaccident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE JX HIRED AUTOS X AUTOS Per accidarA $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 S EXCESSLIAS CLAIMS-MADE AGGREGATE $ 2,000,000 DED I I RETENTION$ ACPCR72203564929 8/27/2010 8/27/201.9 $ WORKERS COMPENSATION PERT OTH- AND EMPLOYERS'LIABILITY STAUTE ER ANY PROPRIETORIPARTNEWEXECUTIVE YIN E.L-EACH ACCIDENT $ 1,000,000 C OFFICER/MEMBEREXCLUDE67 OOfi779i-OS 8/27)203,6 0/27/2014 {Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,D00,000 11 ins describe under DESCRIPTION OF OPERATIONS balm E.L-DISEASE-POLICY LIMIT $ 1,000,000 D Professional Liability NJA314122 12/16/2017 12/16/2018 Limit $500,000 Deductible $5,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(ACORO 101,Additional Remarks Schedule,maybe attached if more space is required) CERTIFICATE HOLDER CANCELLATION mcarr @orangecountync.gov SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange C aurlty THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Department of Environment, Agriculture, ACCORDANCE WITH THE POLICY PROVISIONS. Parks and Recreation PO Box 8181 AUTHORIZED REPRESENTATIVE Hi.11aborough, MC 27278 n—o Ail/1�.D14 rk'U�li CDk�IuN. All rights reserved. ACORD 25(2614101) The ACORD name and logo are registered ma . of ACORD INS025(201401)