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DocuSign Envelope ID: D7D97625-274B-4FD2-B140-A54CC257D87C <br /> NORTH CAROLINA FARM BUREAU MUTUAL INSURANCE COMPANY, INC. <br /> CERTIFICATE OF LIABILITY INSURANCE <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMA TION 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 Linda B Roberts CERTIFICATE Orange County <br /> NAME AND DBA J V Brockwell HOLDER PO Box 8181 <br /> ADDRESS 8821 Old NC 86 Hillsborough, NC 27278 <br /> Chapel Hill, NC 27516 <br /> ) <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 SUER POLICY NUMBER POLICY Y POLICY LIMITS <br /> ID I YYY) (MMDD/YYY) <br /> ® COMMERCIAL GENERAL LIABILI GL 0522126 4/5/2017 4/5/2018 GENERAL AGGREGATE $2,000,000 <br /> PRODUCTS-COMP/OPS <br /> OCCURRENCE 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 $100,000 <br /> PREMISES(Ea Occurrence) <br /> MED EXP(Any ono person) $5,000 <br /> ❑ EACH OCCURRENCE $ <br /> BUSINESSOWNERS AGGREGATE $ <br /> COMBINED SINGLE LIMIT $1,000,000 <br /> UTOMOBILE LIABILITY (Each accident) <br /> BAP 2113218 4/20/2017 10/20/2017 BODILY INJURY(Per person) $ <br /> ❑ SCHEDULED AUTOS — a <br /> ❑ HIRED AUTOS BODILY INJURY(Per accident) $ <br /> ❑ PROPERTY DAMAGE $ <br /> NON-OWNED AUTOS (Per accident) <br /> ❑ GARAGE LIABILITY <br /> ❑ (Other) <br /> EACH OCCURRENCE $ <br /> ❑ EXCESS LIABILITY– AGGREGATE $ <br /> OCCURRENCE <br /> WC STATUTORY LIMITS _ <br /> ❑ WORKERS COMPENSATION N/A E.L.EACH ACCIDENT $ <br /> AND EMPLOYERS'LIABILITY <br /> E .DISEASE-EA EMPLOYEE $ <br /> POLICY APPLIES TO THE WORKERS <br /> COMPENSATION LAW IN THE STATE OF NC E.L.DISEASE-POLICY LIMIT $ <br /> OTHER: <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 Robbie Norris <br /> DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. DATE 5/04/2017 <br /> COI 0910 <br />