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DocuSign Envelope ID:2D2617C6-D4AC-40D4-85B2-275F04B41BC6 DATE(MMlDDIYYYY) <br /> A+CQRD CERTIFICATE OF LIABILITY INSURANCE 3/28/2019 <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 DR 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 1NSURER(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 /> 9 SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on <br /> Ibis certificate doss not confer rights to the certificate holder in lieu of such endorsements), <br /> PRODUCER CONTACI <br /> NAME J. DAVI D BALLARD <br /> BALLARD AGENCY INC PHONE 919 732-2158 FAXC (919)732--9636 <br /> C No Ew A1C NO <br /> P❑ Box 1559 a'DORIFss:ballard@ballarda enc inc.com <br /> Hillsborough, NC 27278 INSURER(S) AFFORDING COVERAGE NAIC t <br /> INSURER A.NEW HAMPSH IRE INSURANCE CO. <br /> INSURED MATTHEW S. JARRELL LAND SURVEYING PLLC INSURER 8: <br /> 314 YORKTOWN DRIVE INSURER <br /> CHAPEL HILL. NC 27516 INSURERD. <br /> INSURER E <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: 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 I TYPE OF INSURANCE L SURR POLICY FF POLICY EXP LIMITS <br /> LTR INSD WVD POLICY NUMBER MM/DD1YYYY MWDDIYYYY <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ <br /> CLAIMS-MADE CI OCCUR PREMISES JEauccurFenqel $ <br /> MED EXP{Any one person} $ <br /> PERSONAL&ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ <br /> POLICY r JECT F1 LOG PRODUCTS-COMPIOP AGG $ <br /> OTHER $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLEL $ <br /> Ea accident <br /> ANYAUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY{Per accident} $ <br /> HIRED NOWOWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> S <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE 5 <br /> LESS LIAB CLAIM&MADEi AGGREGATE !$ <br /> DELI . RE NT ION: $ <br /> WORKERS COMPENSATION SPER OTH. <br /> TATUTE ER <br /> AND EMPLOYERS' LIABILITY YIN <br /> ANY PNDPRIETOI-yPARTNFR+F%ECLITtVE <br /> OFFICEMEMBER E%CLLIDED? ElN;A E.L EACH ACCIDENT <br /> W1 $ <br /> Mwnd-10ly In NHI E.L.DISEASE-FA EMPLOYE $ <br /> II yes,descrlbe under <br /> DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT S <br /> PROFESSIONAL EACH CLAIM 1 ,000,000 <br /> A LIABILITY 064992491-01 4/20/184/20/19AGGREGATE 1 ,000, 000 <br /> DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES (ACORD 101.Additional Remarks Schedule.may be attached IL MOTa space IS required; <br /> CERTIFICATE FIOLDFR CANCELLATION <br /> Triangle Land Conservancey SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> 514 S.Duke St. ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Durham, NC 27701 <br /> AU TH E REPRESENTATIVE <br /> C1JJ 1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD25(2016/03) The ACORD name and logo are r gistered marks of ACORD <br />