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DocuSign Envelope ID: 3DB374A3-B62C-473A-9F1 C-5136A1 B81945E <br /> NORTH CAROLINA FARM BUREAU MUTUAL INSURANCE COMPANY, INC. <br /> CERTIFICATE 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(ies) 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 Richard Crank Photography CERTIFICATE Carla Banks <br /> NAMEAND DBA Pix by Rick Photography HOLDER Director of Public Affairs <br /> ADDRESS Richard Crank Grange County GoVernement <br /> 4308 Mantua Way 200 South Cameron St <br /> Raleigh NC 27004 Hillsborough NC 27278 <br /> email : CBanks(@,orangecountync.gov <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 ADDL:SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br /> INSD MMlD MIWDD <br /> ❑ COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE $ <br /> -OCCURRENCE PRODUCTS-COMPIOPS <br /> AGGREGATE $ <br /> GEN'L AGGREGATE APPLIES PER POLICY PERSONAL&ADV INJURY $ <br /> EACH OCCURRENCE $ <br /> DAMAGE To RENTED $ <br /> PREMISES Ea occurrence <br /> MED EXP(Any one person) $ <br /> ® EACH OCCURRENCE $1)0001000 <br /> BUSINESSOWNERS BSN-0922150 09/05/2013 09/05/2014 AGGREG ATE <br /> COMBINED SINGLE LIMIT $ <br /> AUTOMOBILE LIABILITY {Each accident} <br /> ❑ SCHEDULED AUTOS BODILY INJURY(Per person) $ <br /> ❑ HIRED AUTOS BODILY INJURY(Per accident) $ <br /> ❑ NON-OWNED AUTOS PROPERTY DAMAGE $ <br /> Per accident <br /> 1-1 GARAGE LIABILITY <br /> (Other) <br /> EACH OCCURRENCE $ <br /> ® EXCESS LIABILITY-� <br /> OCCURRENCE AGGREGATE $ <br /> WC STATUTORY LIMITS <br /> ❑ WORKERS COMPENSATION <br /> NIA <br /> AND EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ <br /> POLICY APPLIES To THE WORKERS E.L.DISEASE_EA EMPLOYEE $ <br /> COMPENSATION LAW IN THE STATE OF NC E.L.DISEASE-POLICY LIMIT $ <br /> OTHER: <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES: <br /> Y <br /> CANCELLATION <br /> AUTHORIZED REPRISE ITATIVE <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED :nom <br /> BEFORE THE EXPIRATION DATE THEREOF NOTICE WILL BE �• `�'.;t � :h. „w...: 5 <br /> DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. DATE 08/2012014 "y ` <br /> f. <br /> r•: <br /> COI 0910 <br />