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DocuSign Envelope ID:356CF144-9145-419B-82D1-1 F4A9099C3BD <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 <br /> CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER <br /> THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE <br /> A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE <br /> CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION <br /> IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement <br /> on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br /> INSURED BRIAN D ASHBURN CERTIFICATE RENEE D HOLMES <br /> NAME AND 110 HILLSIDE DR HOLDER HOUSING PROGRAMS COORDINATOR <br /> ADDRESS LOUISBURG NORTH CAROLINA 27549 ORANGE COUNTY HOUSING , HUMAN <br /> RIGHTS AND COMMUNITY DEVELOPMENT <br /> 300 W. TRYON STREET <br /> HILLSBOROUGH , NC 27278 <br /> COVERAGES <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED <br /> NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR <br /> CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE <br /> ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL <br /> THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY <br /> PAID CLAIMS. <br /> X TYPE OF INSURANCE ADDLSUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br /> INSD WVD (MMlDDlYYYY)(MMIDDIYYYY) <br /> Es COMMERCIAL GENERAL To be assigned 04/19/2017 04/19/2018 GENERAL AGGREGATE $2,000,000 <br /> LIABILITY-OCCURRENCE PRODUCTS-COMP/OPS $2,000,000 <br /> AGGREGATE <br /> PERSONAL&ADV INJURY $1,000,000 <br /> GEN'L AGGREGATE APPLIES PER EACH OCCURRENCE $1,000,000 <br /> POLICY <br /> DAMAGE TO RENTED $100,000 <br /> PREMISES (Ea Occurrence) <br /> MED EXP (Any one person) $5,000 <br /> © BUSINESSOWNERS EACH OCCURRENCE <br /> _AGGREGATE <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> LI SCHEDULE AUTOS (Each accident) <br /> ❑ HIRED AUTOS BODILY INJURY(Per person) <br /> ❑ NON-OWNED AUTOS BODILY INJURY(Per accident) <br /> ❑ GARAGE LIABILITY PROPERTY DAMAGE <br /> ❑ (Other) (Per accident) <br /> EXCESS LIABILITY- EACH OCCURRENCE <br /> ❑ OCCURRENCE AGGREGATE <br /> WORKERS WC STATUTORY LIMITS <br /> COMPENSATION AND N/A <br /> ❑ EMPLOYERS' LIABILITY E.L. EACH ACCIDENT <br /> POLICY APPLIES TO THE WORKERS E.L. DISEASE- EA EMPLOYEE <br /> COMPENSATION LAW IN THE STATE - <br /> OF NC E.L. DISEASE-POLICY LIMIT <br /> ❑OTHER: <br /> DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES: <br /> CANCELLATION AU •RIZED REPRESENTATIVE <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED <br /> BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DATES /67-74V7 <br /> DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ilk' <br /> COI 0910 <br />