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NORTH CAROLINA FARM BUREAU MUTUAL INSURANCE COMPANY, INC. <br /> CERTIFICATE OF LIABILITY INSURANCE <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(les)must be endorsed.If SUBROGATION IS WAIVED,subject <br /> to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to <br /> the certificate holder in lieu of such endorsement(s). <br /> INSURED BEN A BERGMANN CERTIFICATE ORANGE COUNTY NC PFAP <br /> NAMEAND DBA FICKLE CREEK FARM HOLDER 500 VALLEY FORGE ROAD <br /> ADDRESS 4122 BUCKHORN ROAD HILLSBOROUGH NC 27278 <br /> EFLAND NC 27243 pfap@CO.orange.nc.us <br /> COVERAGES <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 /> X TYPE OF INSURANCE ADDLSUBR POLICY NUMBER POLICY EFF PNOULIICY EXP LIMITS <br /> ® COMMERCIAL GENERAL LIABILITY x SMP 0124556 3/28/2011 3/28/2012 GENERAL AGGREGATE $1,000,000 <br /> -OCCURRENCE AGGREGATE COMP/OPS $1,000,000 <br /> GEN'L AGGREGATE APPLIES PER POLICY PERSONAL 6 ADV INJURY $1,000,000 <br /> EACH OCCURRENCE $1,000,000 <br /> DAMAGE TO RENTED <br /> n $100 000 <br /> E <br /> MED EXP(Any one person) $5,000 <br /> ❑ EACH OCCURRENCE $ <br /> BUSINESSOWNERS AGGREGATE <br /> AUTOMOBILE LIABILITY (Ech accident) LIMIT $ <br /> ❑ SCHEDULED AUTOS BODILY INJURY(Per person) $ <br /> ❑ HIRED AUTOS BODILY INJURY(PeraccldeM) $ <br /> ❑ NON-OWNED AUTOS PROPERTY <br /> er accident) GE $ <br /> ❑ GARAGE LIABILITY <br /> ❑ (Other) <br /> EACH OCCURRENCE $ <br /> ❑ EXCESS LIABILITY— AGGREGATE $ <br /> OCCURRENCE <br /> WCSTAMORYUMITS <br /> ❑ WORKERS COMPENSATION N/A E.L.EACH ACCIDENT $ <br /> AND EMPLOYERS'LIABILITY <br /> E.L.DISEASE-EA EMPLOYEE $ <br /> POLICY APPLIES TO THE WORKERS <br /> COMPENSATION LAW IN THE STATE OF NC E.L.DISEASE-POLICY LIMIT $ <br /> OTHER: <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES: <br /> CANCELLATION _ <br /> AUTHORIZED REPRESENTATIVE <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED <br /> BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE <br /> DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. DATE 12/15/2011 <br /> COI 0910 <br />