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DocuSign Envelope ID:8D52AF4C-1EDC-4D62-A3C0-94DC276AC40F <br /> , ► CERTIFICATE OF LIABILITY INSURANCE °�'�IDV201 " <br /> i CJ41?2018 <br /> THIS CERTIFICATE IS ISSUED AS A MAMR OF INFORMATION ONLY AND CONFERS NO RIGJA1 UPON THE CERTIFICATE HOLDEN. THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEN ID, EXTEND OR ALTER THE COVERAGE AFFORDEn BY THE POOCIES <br /> BELOW. THFS CERTIFICATE OF INSURANCE DOES NOT CONSTTFUTE A CONTRACT BETWEEN THE ISSUING Kn :IJRER($), AUTHORIZED <br /> RE hFRESENTATIVE OIL PRODUCER.AND THE CERTEFICATE HOLDER. <br /> IMPORTANT: tf the certificate holder is an ADDITIONAL INSURED,1 w policy(las)must be cndorsed. If SUBROGATION IS WAIVED,Subject to the <br /> twins and conditions of the poiicyr, certain policies may require an erldomernerrL A statement on #his ccrnlfmG does riot confer rights to tha <br /> ce4tiTir,ate boldw in lieu of such endarsen nt{s}, <br /> TAluT <br /> "omc"' Greg LDpefman, CPCU G4N T GPeg ldpemaln <br /> State Farm Insurance ari°"E 9i-933.7770 _ 4AM u.I.s1� }Zip <br /> 1 4 NC Noy 5 UV ApoRE.GrN eman,WSLQS'�V farm-o n <br /> A— —aftoro, NC 27510 �U�W�J AfF4R41NC COYPRwc� .,,u�� <br /> INSUW-RA:Stale Farm Fire and Casually'�j)orks+ 25143 <br /> v[SIIRCR RILEY SURVEYING PA INSUFM S:State Farm I.�ulue[AwomabiW[nsur�rlc�_Comn®rnr 9 . <br /> STE 1008 MLMERC — - <br /> 3326 DURHAM CHAPEL.HILL BLVD "AFAD= - <br /> DURHAM NO 27707-2695 INSURERE= — <br /> INSORER F: <br /> COVERAGES CERTIFICATE NUMBER.- REVIS*N NUMBER: <br /> IHIS IS 713 CERTIFY THAT THE POLICIES OF INSURANCE LISTED Eg-LOW HAVE ECEN ISSUFzo TO THE INSURED NAM-fvo ABOVE FOR THE POLICY PERIOD <br /> INJDICATEO, NOTWITRSTANDII%li, ANY REQUIREMENT,TERM OR CONDMONl OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPrmcT TO WFII H THIS <br /> CERTIFY-ATE MAY 9E 18SUED OR UAY PERTAIN, THE iNSURANCE Af FOCWMBD h3Y THE PDOCIES DE$CLR*W HEREfR JS SUBJECT TO ALL TIE TERXT$, <br /> EXCLUSIONS MIC CONDITIONS OF SUCH POLICIES-LIMITS SHMN MAY HAVE SIrEN REDUCe D BY P_AID CLAWS. <br /> wale TYPE OF1NtUFjM4CE AnnLB VjLm P4L1CY .K�' P 6C7 M 1erLTFL y <br /> mmog4LLL%E Jrlr Y 93 GG,Z005 02f2rt2ma Q2t2b12019 EACH OCI'LIRRENCE I 1.I44.f1150 <br /> COMiMCRCIAL GENERAL LIAUILRY PRENt6ES a noaunvr & S 740,{}04 <br /> CLAIMSi-MADE MCUR MED Ow(wyy one ersrn} 1 5 S,oPP <br /> KRSOKAL&ADV INAPRY 8 t,00¢,4U0 <br /> _ GIENEROSL GGRECa7E S {100,f]gp <br /> GEWLA156A)EGATEL[MUTarPLICSP&R} PJ FR(MCTs-COMDRA_GG 3 2,000,{1d0 <br /> �. POLICY JEM <br /> PR& f LUC S <br /> h3 AWFONKMB ELIAEaJrY 0719714-D34-33 D413012018 04U QtZI)19 &2 D, w€�LELr er S <br /> NYALTTO 0001LY INJURY MtorPw%m] $bq,ppp <br /> ALL CriAmiF4 SCHEOULED ROINLY INJURY fvw accKW} $ 500,000 <br /> All! AUTOS <br /> HIRE-DALi'OS pq AUTOS NON-OWNED �3otidwt1 E S 100-0U0 <br /> 5 <br /> A LeLaReLLn4rAa { 00Cuft 93fisM-1111-1 fl8ttol2glll 413l44Y#414 €ACHOCCLMAENCE >t 1-�44,fid(r <br /> fXCESt L!AU CLAIMS-NIADE AG4REGA_-M <br /> r,IEDX RETENTIONS 10000 $ <br /> A WORKERS013WEMSAMN Y3GSTA3Li• <br /> AND IMPLOYEAW 41ABILTY <br /> Y f N <br /> ANY PKQPRSETCQJPARTUEfaYnUVTrVE f.L E:aCl-eACC10€FfT 5 �,♦ 95)0 <br /> DF=ICE% WM5ff1 EXCLUDED? � NPA 93•CV�457-5 D2f2012018 D y2Q19 <br /> JF&Rdatary en wrq E1-❑ISEASE-EA I<MMPL 1r t,d00,000 <br /> ■sue,dcxee14a c n&d :P 0 DFSEASE-F L3CY Uwr S 1.ta44.00CI <br /> 13E'&MPTM OF GVERATM3 i LOCATWHS i VEHICLES[Attaph Pr"b ia+,Addhloml FZWnVhl 3d zduW 7 Mum space Is mMUIrlq!) <br /> CERTIFICATE HOLDER CANCELLATION <br /> Orange$ County SFRAJLD ANY OF THE ABOVE DE3CRPMD POLICIES BE CANCELLED BEFORE <br /> ty THE E PRATION DATX Ta`EREOP. NOTICE WtLL eF DELIVERED IN <br /> PO Box 8181 ACCORDANCE W TH TAE POLICY PROVISIONS. <br /> Hillsborough, NC 27278 f <br /> AtpTl-ID RF,PRESEPeTAT] <br /> i <br /> 198 0 AWED MRPORATION- !UI rights reserved- <br /> ACORD;5;20101D5) The ACORD name and lop are regliatemdCrks ofACORD 1041486 1132EW).63 11-15-2010 <br />