2019-015-E DEAPR - Landmark Walker Farm survey

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DocuSign Envelope ID:37AB50D1-7349-4815-9C2B-6645EC129BB1 A�Ro® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 1/3/2019 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 CONTACT NAME: Debby Blanchard Glick and Mahan a/c NNo Ext: (336)228-0525 AAA No: (336)229-0900 2326 S Church St Ste C E-MAIL blanchd3@nationwide.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Burlington NC 27215 INSURER A:Nationwide Mutual Property & Casualty C 37877N INSURED INSURER B:Nationwide Mutual Fire Insurance Compar 23779N Landmark Surveying Inc INSURERC:First Comp PO Box 839 INSURER D:Argonaut Insurance Company INSURER E: Graham NC 27253-0839 INSURERF: COVERAGES CERTIFICATE NUMBER:CL18122101893 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 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. INSR ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE ❑X OCCUR DAMAGE TO100,000 PREMISES Ea occurrence $ ACPGLK02203584929 8/27/2018 8/27/2019 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ❑ PRO JECT ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED AUTOS X AUTOS ACPSAK2203589929 8/27/2018 8/27/2019 BODILY INJURY(Per accident) $ X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,000 B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DED I I RETENTION$ 0 ACPCAF2203584929 8/27/2018 8/27/2019 $ WORKERS COMPENSATION x PER I OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT I $ 1,000,000 OFFICER/MEMBER EXCLUDED? Y❑ N/A C (Mandatory in NH) MWC0067791-05 8/27/2018 8/27/2019 EL DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 D Professional Liability 121AE000271600 12/18/2018 12/18/2019 Limit 500,000 Deductible 5,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: Walker Farm Conservation Easement CERTIFICATE HOLDER CANCELLATION klivingston@orangecountync.gc SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County 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 Hillsborough, NC 27278 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)