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DocuSign Envelope ID:ODO6ADD8-36E0-405B-96F0-B574A8D290B3 <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 DOUG MALINOWSKI JR CERTIFICATE ORANGEE COUNTY PLANNING AND <br /> NAME AND DBA WELLSMONT LANDSCAPING HOLDER INSPECTIONS DEPARTMENT <br /> ADDRESS 1005 DIMMOCKS MILL ROAD 131 W MARGARET LANE <br /> HILLSBOROUGH, NC 27278 PO BOX 8181 <br /> HILLSBOROUGH, NC 27278 <br /> EMAIL: <br /> AREINERT @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 NSD WVD POLICY NUMBER POLICY M/D /YYW) POLICY M//D //YYYY) LIMITS <br /> ® COMMERCIAL GENERAL LIABILITY X GL 0483161 2/23/2017 2/23/2018 GENERAL AGGREGATE $1,000,000 <br /> -OCCURRENCE PRODUCTS-COMP/OPS <br /> AGGREGATE $ <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 $ <br /> (Each accident) <br /> ❑ SCHEDULED AUTOS BODILY INJURY(Per person) $ <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 /> WC STATUTORY LIMITS <br /> ❑ WORKERS COMPENSATION N/A <br /> AND EMPLOYERS'LIABILITY WCO253741 8/24/2016 8/24/2017 E .EACH ACCIDENT $100,000 <br /> POLICY APPLIES TO THE WORKERS E .DISEASE-EA EMPLOYEE $100,000 <br /> COMPENSATION LAW IN THE STATE OF NC <br /> E .DISEASE-POLICY LIMIT $500,000 <br /> OTHER: <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES: <br /> CANCELLATION r` <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 7/26/2017 • <br /> COI 0910 <br />