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DocuSign Envelope ID: 0004336D-BBE2-4675-B7DF-226F5C0932F0 <br /> GS286204 <br /> ACC i ® DATE(MMIDDIYYYY) <br /> A 1 y® CERTIFICATE OLIABILITY INSURANCE 01/06/2017 <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 to <br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER NAME:ACT Mike Garrison <br /> MAST & GARRISON, INC. <br /> 439 SOUTH SPRING STREET (IAlC o,Ext): 336-226-4474 FAX <br /> (NC, 336-226-4535 <br /> P.O. BOX 340 ADDRESS: mandgins @mindspring.com <br /> BURLINGTON NC 27215 INSURER(S)AFFORDING COVERAGE NAIC# <br /> INSURERA:SCOTTSDALE INSURANCE COMPANY 41297 <br /> INSURED INSURER B: <br /> HOOF BEAT FARM LLC <br /> 2401 NC 57 INSURER C: <br /> HILLSBOROUGH NC 27278 INSURER D: <br /> INSURER E: <br /> INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <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 /> INSR <br /> LTR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP <br /> INSR WVD POLICY NUMBER (MMIDD/YYYY) (MMIDD/YYYY) LIMITS <br /> GENERAL LIABILITY CPS2590192 01/06/2017 01/06/2018 EACH OCCURRENCE $1,000,000 <br /> A X COMMERCIAL GENERAL LIABILITY PR S RENTED <br /> PREMISES((Ea occurrence) $100,000 <br /> CLAIMS-MADE X OCCUR MED EXP(Any one person) $5,000 <br /> PERSONAL&ADV INJURY $1,000,000 <br /> GENERAL AGGREGATE $2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 <br /> X POLICY PRO- LOC $ <br /> JECT <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> (Ea accident) <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS _AUTOS <br /> HIRED AUTOS NON-OWNED PROPERTY DAMAGE <br /> AUTOS (Per accident) <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION WC STATU- OTH- <br /> AND EMPLOYERS LIABILITY YIN TORY LIMITS ER <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBER EXCLUDED? <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) <br /> SNOW PLOWING. <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> ORANGE COUNTY AUTHORIZED REPRESENTATIVE <br /> PO BOX 8181 <br /> HILLSBOROUGH, NC 27278 <br /> ©1988-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD <br />