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DocuSign Envelope ID:679A1513-C801-4852-9D94-A46AADDBBAE6 <br /> 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 Linda B Roberts CERTIFICATE Department of Environment <br /> NAME AND DBA J V Brockwell HOLDER Agriculture, Parks and Recrtion <br /> ADDRESS 8821 Old NC 86 6823 Mlllhouse Rd <br /> Chapel Hill NC 27516 Chapel Hill NC 27516 <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 ADDLSUSR POLIGYNUMBER POLDIC EF "P, <br /> NU CYEX LIMITS ^ <br /> ® COMMERCIAL GENERAL LIABILITY GL 0522126 4/5/2016 4/5/2017 GENERAL AGGREGATE s2,000,000 <br /> OCCURRENCE PRODUCTS-COMPIOPS <br /> AGGREGATE $2,000,000 <br /> GEN'L AGGREGATE APPLIES PER POLICY PERSONAL&ADV INJURY $1,000,000 <br /> EACH OCCURRENCE _ $1,000,000 <br /> DAMAGE TO RENTED $1OO,fl00 <br /> Us Occurcer"j <br /> MED EXP(Any one person) $5,000 <br /> ❑ BuslNESSOwNERs EACH OCCURRENCE $ <br /> AGGREGATE $ <br /> COMBINED SINGLEWAn' $,0{30,000 <br /> AUTOMOBILE LIABILITY (EachaWdent) <br /> ® BAP 2193218 412012016 10/2012016 130DILYINJURY(Perperson) <br /> SCHEDULED AUTOS $ <br /> ❑ HIRED AUTOS BODILY INJURY(Per aceldent) $ <br /> Q NON-OWNED AUTOS -1Pa7 DAMAGE $ <br /> ❑ GARAGE LIABILITY <br /> ❑ (Other) <br /> El LIABILITY_ EACH OCCURRENCE $ 1 <br /> OCCURRENCE AGGREGATE $ I <br /> WCSTATUTORYi NIIrS I <br /> ❑ WORKERS COMPENSATION NIA <br /> AND EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ <br /> POLICY APPLIES TOTHE WORKERS E.L.DISEASE-EAEMPLOYEE $ 3 <br /> COMPENSATION LAW IN THE STATE OF NO E.L.DISEASE-POLICY LIMIT $ <br /> OTHER: <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS!VEHICLES: <br /> CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED AUTHORIZED REPRESENTATIVE t <br /> BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE Robbie Norris <br /> DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. DATE 5/20(2016 <br /> Col 0910 <br />