2017-365-E Planning - Wellsmont Landscaping - annual mowing of Lake Orange dam

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DocuSign Envelope ID:ODO6ADD8-36E0-405B-96F0-B574A8D290B3 BAP 2177023 2, 705 NORTH CAROLINA FARM BUREAU MUTUAL INSURANCE COMPANY PART B DECLARATION PAGE P.O.BOX 27427 RALEIGH,NORTH CAROLINA 27611-7427 BUSINESS AUTO POLICY POLICY RENEWAL DECLARATION — COVERAGE WILL ITEM ONE— EXPIRE ON 02/24/17 IF PREMIUM IS NOT PAID. :..'.::::-:-:::.:�.: °:::.°_.::gamey:p�aat�a:a z°';: =:: '::.::::.::::.�-:: .:;..:•.::.::'A:.'E: ? `: ::!:E:�--`°€s:°;_::,_€-:.:;::;:_:=:::::;:.°::_........_.•.:::a :.,: .......:;€, OY...Ni1Mt�EI�............................. _........................:.....: .............__.. 1N�A�B�Rz 3HtF�.�d[�,......................................................................................__...:.__....��3 BAP 2177023 02/24/17 08/24/17 1644652 BAP DELL 0515 0685538 _NAMM D iNg RE ANRAP RII:S : E ::,::::::;:::r-.:.-::::-:::.:;:::::::-::::::;;_.€._:.:;_::::: ::: ::-.:::_::::::. :il:El MEti i "i_`;_ ;-:!: :° :€_: DOUG MALINOWSKI JR DBA WELLSMONT LANDSCAPING 1740 JOHNSON RD WILL LAWS II, LUTCF BURLINGTON, NC 27217-8179 TELE: (919) 732-7430 110 MILLSTONE DR HILLSBOROUGH, NC 27278 FORM OF NAMED INSUREDS BUSINESS— INDIVIDUAL ITEM TWO— SCHEDULE OF COVERAGES AND COVERED AUTOS THIS POLICY PROVIDES ONLY THOSE COVERAGES WHERE A CHARGE IS SHOWN IN THE PREMIUM COLUMNS BELOW. EACH OF THESE COVERAGES WILL APPLY ONLY TO THOSE AUTOS SHOWN AS COVERED AUTOS. AUTOS ARE SHOWN AS COVERED AUTOS FOR A PARTICULAR COVERAGE BY THE ENTRY OF ONE OR MORE OF THE SYMBOLS FROM THE COVERED AUTO SECTION OF THE BUSINESS AUTO COVERAGE FORM NEXT TO THE NAME OF THE COVERAGE. " COVERAGES COVERED LIMIT— THE MOST WE WILL PAY FOR PREMIUM AUTOS ANY ONE ACCIDENT OR LOSS LIABILITY INSURANCE 07 $500, 000 $258.00 AUTO MED. PAY. INS. 07 $5, 000 EA PERSON $24.00 UNINS/UNDRINS MTR BI 07 $500, 000 EA PERSON $500, 000 EA ACCIDENT $74. 00 UNINSURED MTRST PD $500, 000 PER ACCIDENT $4.00 PHYSICAL DAMAGE INS. ACTUAL CASH VALUE OR COST OF REPAIR, WHICHEVER IS LESS MINUS— DEDUCTIBLE SHOWN COMPREHENSIVE 07 SEE ITEM THREE FOR DEDUCTIBLE FOR EACH $122. 00 COVERED AUTO FOR ALL LOSS EXCEPT FIRE OR LIGHTNING COLLISION 07 SEE ITEM THREE FOR DEDUCTIBLE FOR EACH $221.00 COVERED AUTO TOTAL PREMIUM $703. 00 IE.�ry�•�•[ _. . ._ _-'ry--_;_:__ _ EC._:AE �:[f:_. . N.._::;::.'}'.�....7'.:_ 7y ::<::-::::::::;::;:::::: :: ,::.:: ii:E::1.'3'E7'."��`L's..._L1i°Y-Y.i_i_L'�Yi!¥:':FFY.''.�R:i.L.OL�.kJ"y"�?�'rt1L'443.�L3'�-i.�.". �i:'�'��'3_Y�di.:i:EE.".3H�iy""'ai7?�ie�9i�ii iir:�'i�i�'i �iii E:_5.:i:i2i5:lF liA-77N�/.�:''4W"..":�-"}}"^^?'.:..._..:-_-iiiiii"[_��'—�i:�-:�_s:._.__..,..:ii-7':i:-V:ECEiiiiE:'.._:_:_�.:•.[_._._..:?:._[_�..iEEiti_..:"..�_...._}.-}5�l� � ,...:._..{.'_{;_:iEi-:}- i:� ".:'-�::}ii5:-{��:�-'�.�::�:�-c?�nSii�""wry__icii(iF.ii�i Fr: PE,S.??. SI N :3i_..ZRFFULI�Y�::::::' NTACT Y'..'.r.E1i'i"MriN:Sii:'::ie_iFi^M:=is3:niS2."gripYF l* tiS H:::i1: : 1.:..::...__,...:....:.....:....::-._._...;...:ca:::�__.::_:��:::...:......:...:.y.:....:..::.,_-.....:i:':=:?F.ii:_iSi_3S:B::::�3:iSL�2::i'e=X2=:?:=�5;��-�='.-iiii:u3_'�'ri-iiF2T`�_�S :? "iS�� iiiiivc �.t :i :if ii3��r:;si :.� E.. . .::..5 i'u4_' _ .��y'�::.++.xx: ... n._n._:•_:.;: '_'i!S2S C:i—_i_ :r,c-;:_cu;•C;:i7i•:,:i':::IM_i::::ii:'_:S_fii iE_iq:::: 'i�'ii-i?___.�...:-E •: •�T�O � OR•,- §'i��LaEkS[��::..r::�r::::: .:::�x::::�:::,:•:: •:::::::s:•: :::::�:•: ::;::::::::;•::•�r:::::r.:::-:::r:::::::a::::::r:::•::..::::.:::.::::•:r.:�:.:::-��:u., y: I::::: :::::::5::::5:!_:=J::Eii'_:iii2: iii.=-iiS_:iiie' :iiiE3SiSiEiiFiielc:i F i:::?ei:ii Si"ii ct°_ie:k:i5iiitSfi:i Sfii' cf°=tiSiFiEFS;-iciiEi FS_iii2iEiiF:is5iSiiaSiicE:iiS icu?ii:iii: v:<iScei_i_:S:EEFi _i iio:i:::::::t:::r:::: ::::l :::':i::iHi::::Ee"i`-f :::i?01n:is:::i: :i'_ iii ::::::S: 5' fE 'i' ::::=:i:: :n:ii = :5 ?" :[iiii:ii''ii-iii: ' ! ::::"c:::'- - -i:ii ri::E r.:i ici:-:=c'.'":i6.:'iicEz"iiSS-:'a c= :ui''_: i :-::c ::ii-_?i iii E:_cii:::.::::E WE APPRECIATE YOUR BUSINESS.