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DocuSign Envelope ID: 5EA2299C-2546-42C3-AC63-219B5BA6305B <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 CURTUS JOHN-WILLIAM FARMER CERTIFICATE Orange County DEAPR I <br /> NAME AND 4248 N NC HIGHWAY 119 HOLDER 302 W Triton Rd <br /> ADDRESS MEBANE NC 27302 Hillsborough,NC 27278 <br /> cjfarmer54 @gmail.com <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.IILIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> x TYPE OP INSURANCE ADOL SUDR POLICY NUMBER (��POLICY�}YY) (M�POLICY EXP YY) LIMITS <br /> ® COMMERCIAL GENERAL LIABILITY' GENERAL AGGREGATE <br /> $2,000,000 <br /> -OCCURRENCE PRODUCTS-COMPIOPS <br /> AGGREGATE <br /> GEN L AGGREGATE APPLIES PER POLICY GL 0517161 2/9/2016 2/9/2017 PERSONAL S ADV INJURY $1,000,000 <br /> EACH OCCURRENCE $1,000,000 <br /> DAMAGE TO RENTED 100,000 <br /> PREMISES(Ea Occu senceL_, Iq <br /> MED EXP(Any one person) $5,000 E <br /> ❑ BUSINESSOWNERS EACH OCCURRENCE $ <br /> AGGREGATE $ <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 <br /> GARAGE LIABILITY <br /> ❑ (Other) <br /> ID LIABILITY— EACH OCCURRENCE $ <br /> OCCURRENCE AGGREGATE $ <br /> WC STATUTORY LIMITS <br /> El WORKERS COMPENSATION N/A <br /> AND EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ <br /> E.L DISEASE-EA EMPLOYEE <br /> POLICY APPLIES TO THE WORKERS _ <br /> COMPENSATION LAW IN THE STATE OF NO E.L.DISEASE•POLICY LIMIT $ <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 10/3/2016 // 4 • <br /> COI 0910 Cs) <br />