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2019-241-E DEAPR - Riley Surveying Twin Creeks
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2019-241-E DEAPR - Riley Surveying Twin Creeks
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Last modified
4/26/2019 11:09:48 AM
Creation date
4/26/2019 11:05:42 AM
Metadata
Fields
Template:
Contract
Date
4/12/2019
Contract Starting Date
4/12/2019
Contract Ending Date
5/17/2019
Contract Document Type
Contract
Amount
$3,500.00
Document Relationships
R 2019-241 DEAPR - Riley Surveying Twin Creeks
(Attachment)
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\Board of County Commissioners\Contracts and Agreements\Contract Routing Sheets\Routing Sheets\2019
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DocuSign Envelope ID: F8057E6E-3837-4DFE-AEF9-BD8F83298798 <br /> A ��0 CERTIFICATE OF LIABILITY INSURANCE DATE(M 04/16//2019 Y) <br /> 019 <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 have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on <br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT Trish Clark <br /> NAME: <br /> Trustpoint Insurance aCONN. Ext: (540)389-0261 ac,No): (888)872-5496 <br /> 16 East Church Ave E-MAIL tclark@trustpointins.com <br /> ADDRESS: <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> Roanoke VA 24010 INSURERA: AXIS Insurance Company <br /> INSURED INSURER B: <br /> Riley Surveying,P.A. INSURER C: <br /> 3326 Durham Chapel Hill Blvd INSURER D: <br /> INSURER E: <br /> Ste B-100 Dur NC 27707 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 18-19 Master REVISION NUMBER: <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 /> INSR ADDLSUBR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS <br /> LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ <br /> DAMAGE To CLAIMS-MADE OCCUR PREMISES Ea occurrence)l <br /> $ <br /> MED EXP(Any one person) $ <br /> PERSONAL&ADV INJURY $ <br /> GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ <br /> POLICY ❑ PRO ❑ LOC PRODUCTS-COMP/OP AGG $ <br /> JECT <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> (Ea accident) <br /> ANYAUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY (Per accident) <br /> r $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED I I RETENTION $ $ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA <br /> E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> Professional Liability Per Claim $1,000,000 <br /> A AEA003488-01-2018 08/10/2018 08/10/2020 Aggregate $2,000,000 <br /> Deductible $2,500 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN <br /> Orange County Environmental Agriculture, ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Parks and Recreation <br /> AUTHORIZED REPRESENTATIVE <br /> 306A Revere Road <br /> Hillsborough NC 27278 !</ <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />
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