2019-315-E DEAPR - Landmark Surveying Windy Hill conservation

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DocuSign Envelope ID:250A6487-28BB-496A-ABAA-784lA556379C DATE IMMIDDIYYYYI A D® CERTIFICATE OF LIABILITY INSURANCE 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 he 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 HAMS: Debby Blanchard Glick and Mahan PHONE (336)228-0525 PAX [336y 22g-as00 AIC No Est AIC,No 2326 S Church St Ste C E-MAIL blanchd3@nationwide.com ADDRESS: INSURERS]AFFORDING COVERAGE NAIC# Burlington NC 27215 INSURERA: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 CONTRACT OR 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 LTR TYPE OF INSURANCE INSD WVID POLICY NUMBER MWDDIY MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 A CLAIMS-MADE ❑X OCCUR DAMAGE TO RENTED $ 100,000 PREMISES Ea occurrence 4.CPGLx02203580929 8/27/2018 8/27/2019 MED EXP(Any one person) S 51000 PERSONAL&ADV INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 X POLICY ❑PRO JECT ❑LOC PRODUCTS-COMPIOPAGG S 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMB.NEO SINGLE LIMIT $ 1,DOO,OOD Es accidenl A ANY AUTO BODILY INJURY(Per person) S ALL OW NE❑ M SCHEDULEDACPBAK2203584929 8/27/2029 a/27/2019 BODILY INJURY(Per accident) S AUTOSAUTOSX NON-OWNED PROPERTY DAMAGE 8 HIRED AUTOSAUTOS Per accidenl S X UMBRELLA LIAB OCCUR EACH OCCURRENCE s 2,000,000 $ 7 EXCESS LIAB CLAIMS-MADE AGGREGATE s 2,000,000 ❑E❑ I I RETENTION$ 0 ACPCAF2203584929 8/27/2D18 8/27/2019 $ WORKERS COMPENSATION R PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR7PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? � N I A C iMandatory in NH] HS7C0067791-05 8/27/2018 8/27/2019 E.4.DISEASE-EA EMPLOYEE $ 11000,000 11 yes,descnbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 D Professional Liability 121AE000271600 12/19/2018 12/18/2015 Lima 500,000 Deduoi Ne 5,000 DESCRIPTION OF OPERATIONS I LOCATIONS I 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(203401)