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DocuSign Envelope ID:836A3E19-B1A7-4851-B49E-61502EO3900D
<br /> CERTIFICATE OF LIABILITY I ;3
<br /> UR N E � FL(iAWoa'i9
<br /> 0 ��8J2019
<br /> T10s CERTIFICATE IS ISSUED AS A MATTER OF WORMATION ONLY ANO CONFERS NO IJGHTS UPON THE CERTIFICATE HOLDER. THIS
<br /> CERTIFICATE DOES NOT AIFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AF'FORISJ<J�7 BY THE POLICIES
<br /> BELOW_ THIS CERPFIGATE OF INSURANCE DOES NOT COFFST#TIfTE Aw CONTRACT BErwEEN THE ISSUING INBUREI2(S), ALITHORIZZED
<br /> REPRE$ENTATNE OR PRODUCER,AND THE CERTIFICATE HOLDER_
<br /> IMFORTANT-- IF the certlikaig-holder is an ADDITIONAIt INSUREb,the PoIIcYjies}must be endorsed_ If S UBROGATION I.S WAIVED, subject to the
<br /> IerFn4% aril c=nditIchs of the Policy, certain Pofipies may require an Ondw,%merwL A 5tatemerlt on this otrYdficatie does not confer rights to th,-
<br /> Cer#ificate holder In lieu of such undor"mvrd(s}
<br /> FRMUCER Greg LOPLeMan, CP U raw - reg LaoBn-lan
<br /> State Farm ln$uranoe I14ME EKtI 919 33-7TfI? NoI:919-s33 7713
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<br /> arrboro, NC 27510 MuRM%I83AFFOikDII1GCOwPUWE 19AJ00
<br /> msuRER�Farm Fire and Gasua Com ny #3
<br /> IH3kIRF,p RILEYSURVEYING PA WsuRFR B:S�6ate Farm ltiaun al AirWrrrohilc Jr urance Compa„y Fa
<br /> I-E 1008 Iwaul�c� - _
<br /> 3326 DURHAM CHAPEL HJLL SLVD 1HSLffW=RD
<br /> DURHAM NC 27707- 695 Imsur&--RE
<br /> IF3SI.IREk F_ -
<br /> COVERAGES CERTIFICATE NUMBER: REYt.SION NUMBER:
<br /> THIS JS TO CERTIFY THAT PIE POLICIE$ OF INSURANCE LISTED SELM HAVE BEEN ISSI}ED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> INOICATEp_ NOPNI'THSTANDING ANY RFOLIIREMENT, TERM OR CCMITIOr4 OF ANY CONTRAPT OR OTHER OOCUMBdT Wf " RESPECT TO W11ICH THIS
<br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFC4MF* BY THE POLICII±S DESCRQED HEREIN I$ SUejECT TO ALL THE TERMS,
<br /> EXQA,U$IONS AND CONDTIONS OF SUCH POLICIES,LIMITS SHp{I N MAY HAVE BEEN REDUCED Sy PAID CLAIMS,
<br /> LV • TYPE WIN SURA Nur; noL Pow"EIWP6Leer Nu1�ER LRIR8
<br /> GEwF nLLUSBk.ITr1YR,
<br /> 93 r.+_ 0=024i8 0ZMW2M EACHUCX-.AeRENCE $ _ 1,000.0ou
<br /> i CO41MEROIAL GENERAL LIA$IL4TY
<br /> Pt.e%WE5{Esooagrm $ 41J,040
<br /> . CLAIMS-WDE F—x1 OCCUR MEdECP(rurycnePevecn�._
<br /> —'� PERSONA{t.AdV INJURY
<br /> C NERAL"RFGATE L 2,QgQ,(5Qp
<br /> GEHL AGGREGATE LsA3,-APpu I PER: P UCTS.COMM!"AGG S 2,1)00-000
<br /> rx{ POLICY Y FFC� -
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<br /> AUTOMOg1LE LL4&IJT'r I U71 9714-MD 33 10J30l2ff1 B 1 Dt3WMt "' I LE LIMIT $
<br /> AWr AUTO BOULY3k,ILIRY{Perpurn 3 500,0d0
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<br /> 3LE0
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<br /> 1 5 50U,OQ
<br /> HIRE[?AUTOS NON-UVMF.D a � �} AUTp • 5 100,000
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<br /> A LI�IBRELLAr AA OC=R c.rw�CCUFIeE71cC 1« 1,000,044
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<br /> B 93•Gf4t-1S19-1 flJIl9IIf2bIJ# 0811I1f2I129
<br /> CL ..
<br /> AIM$-HADE A2 PIFOATE S 1,(100-000
<br /> AL
<br /> oF. XRCTf_nIrON$ 1000Q I
<br /> A I WORKERS COMPENSATION WCSrAIU- ,OTFF 0
<br /> AMD EMPPLarERg L"ILITY ,r+N
<br /> AFlY PRpPR]E7py,,pgf}iN R+r,KEGUTIVE EL.EhCH,+U~OI4EN£ $ 1,4[�G,O04
<br /> UnCEMEMBEREXCLUOED1 141A 93•CV-R463-3 02020020111 02J7aaJ2d2
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<br /> If 5'ge,dese I RA Fritg Ued9f
<br /> E.LDISEASP- ICY LIMIT I; 1,OOr},q(Fp
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<br /> bEWRWTIGN OF OPPRATION!S e LOCATIONS e VEHICLES Otbdh ACURp 101.hddiNmal Reim.ha Sehedula.ir rkiwa spLam is mgykW
<br /> CERTIFICATE BOLDER
<br /> -CANCELLATION
<br /> Orange County 514OULD All THE ASDVE D}ESCRMBED POLICIES BE CANCELLED BEFORE,
<br /> THE EXPIkAtM UATIE THEREOF, 1`401TCE VWLL BE IDr;LIVEREB JN
<br /> PO Box 8181 ACCO Rp CE WITH THE POMY PROVJSJON$-
<br /> Hillsborough, NC 27278 #
<br /> A 1)KiDF zr�7iA
<br /> �0 1988-2010 ACORD CORD T N. All rights reserved.
<br /> ACORD 25(201OM5) The AC0FZD name and Io96 are registered marks of ACORD f001486 132849.6 11-15�Ot4
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