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DocuSign Envelope ID:C1E6582F-30E7-4FFE-8A42-B792ACDE7CD4 <br /> �® CERTIFICATE OF LIABILITY INSURANCE OATE[MMIDDIYYYYI <br /> D411 612 0 1 9 <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 HOT 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(les)must have ADDITIONAL INSURED provisions o►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 endorsementtsy. <br /> PRODUCER CONTACT Trish Clark <br /> NAME: <br /> Trustpoint Insurance PHONE (540)389-0261 FAX C Na E FAX <br /> (888)872-5496 <br /> Na <br /> 16 East Church Ave E-MAIL tdark®trustpointins.com <br /> ADDRESS: <br /> INSURER(S)AFFCRDING COVERAGE NAIC# <br /> Roanoke VA 24010 INSURERA: AXIS Insurance Company <br /> INSURED <br /> INSURER B <br /> Riley Surveying,P.A. INSURER <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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSU RA NCE AFFOR D E D BY THE POLICIES DESCRIBED HEREIN I SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONSAN❑CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR AIJUL 5UUR POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE likka WVDPOLICY NUM DER MMIDIIM'YY MMIDDrYYYY LIMITS <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S <br /> CLAIMS-MADE ❑OCCUR DAMAGE T RENTED <br /> PREMISE Ea occunence $ <br /> MED E%P(Any one person) s <br /> PERSONAL&ADV INJURY S <br /> GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGAT I- S <br /> POLICY 0 JPET D LOC. PRODUCTS-COMPIOPAGG 5 <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLELIMIIT $ <br /> Ea accident <br /> ANYAUTO BODILY INJURY(Par person) $ <br /> OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Peraccidenl) $ <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accFdenl <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAS HCLAIMS-MADE AGGREGATE $ <br /> DEC) I I RETENTION$ $ <br /> WORKERS COMPENSATION PER pTH- <br /> ANDEMPLOYERS'LIABILITY YrN STATUTE ER <br /> ANY PROPRIETORIPARTNERIEXECUTIVE ❑ NIA <br /> E.L.EACH ACCIDENT $ <br /> OFFICERIMEMBER EXCLUDED? <br /> (Mandatory InNHE E.L.DISEASE-EA EMPLOYEE $ <br /> Ifyes,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 08/1012018 08/10/2020 Aggregate $2,000,000 <br /> Deductible $2,500 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD tat,Additional Remarks Schedule,may be attached if more space Is requl rod I <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 Env ironmentalAgriculture, ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Parks and Recreation <br /> 306A Revere Road AUTHORIZED REPRESENTATIVE <br /> Hillsborough NC 27278 ` 4:to� <br /> 471988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 2512016103) The ACORD name and logo are registered marks of ACORD <br />