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DocuSign Envelope ID: 3C51187C-81C1-49BE-9EED-5FC546BDA75B <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(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 MULBERRY BUILDING CO LLC CERTIFICATE ORANGE CO DEPT OF ENVIRONMENT, <br /> NAME AND 9501 NC HWY 86 N HOLDER AGRICULTURE, PARKS&RECREATION <br /> ADDRESS CEDAR GROVE NC 27231 PO BOX 8181;306A REVERE ROAD <br /> HILLSBOROUGH NC 27278 <br /> psandbeck @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 WVO. (MMIDD/YYYY) (MM/DD/YYYY) <br /> ❑ COMMERCIAL GENERAL LIABILITY GL 0519139 8/1/2016 8/1/2017 GENERAL AGGREGATE $2,000,000 <br /> -OCCURRENCE PRODUCTS-COMP/OPS <br /> AGGREGATE $1,000,000 <br /> GEN'L AGGREGATE APPLIES PER POLICY PERSONAL&ADV INJURY $1,000,000 <br /> EACH OCCURRENCE $1,000,000 <br /> DAMAGE TO RENTED $100,000 <br /> PREMISES(Ea Occurrence) <br /> MED EXP(Any one person) $5,000 <br /> ❑ EACH OCCURRENCE $ <br /> BUSINESSOWNERS <br /> AGGREGATE $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 <br /> (Each accident) <br /> BAP 2173110 8/1/2016 2/1/2017 BODILY INJURY(Per person) $ <br /> • SCHEDULED AUTOS <br /> HIRED AUTOS BODILY INJURY(Per accident) $ <br /> ❑ NON-OWNED AUTOS PROPERTY DAMAGE <br /> (Per accident) _ <br /> ❑ GARAGE LIABILITY <br /> ❑ (Other) <br /> ❑ EXCESS LIABILITY— EACH OCCURRENCE $ <br /> OCCURRENCE AGGREGATE $ <br /> ® WORKERS COMPENSATION WC STATUTORY UMITS r< ` <br /> N/A <br /> AND EMPLOYERS'LIABILITY WC 0251547 8/1/2016 8/1/2017 E.L.EACH ACCIDENT $100,000 <br /> POLICY APPLIES TO THE WORKERS E.L.DISEASE-EA EMPLOYEE $100,000 <br /> COMPENSATION LAW IN THE STATE OF NC E.L.DISEASE-POLICY LIMIT $500,000 <br /> OTHER: <br /> - ❑ <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES: <br /> CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED AUTHORIZED REPRESENTATIVE /. <br /> BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE / / <br /> DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. DATE 8/9/2016 } <br /> COI 0910 <br />