2017-418-E Planning - Wellsmont Landscaping to mow and clear Efland Sewer System

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DocuSign Envelope ID:F4AB36D7-6659-49D9-816A-AC4ABC1AF4D6 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. ::::-:-:::.:�.: °:::.°_.::gar.�cgY:p�a�t�a:a'°';: gall,::::.::::.�-:: �.:;..:•.::.::'A:.'?:?` ? `: ': ':1=�-- € :::: ,_€-:.:;::;:_:=:::::;:.: _........_.•.:::a :..: .......::€, OY...Ni1Mt�EI�............................. _.............................: .............__.. 1N�A�B�Rz 3HtF�.�d[�,......................................................................................__...:.__...��3 BAP 2177023 02/24/17 08/24/17 1644652 BAP DECL 0515 0685538 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 $703. 00 IFit ?iFiiiiieiiin_Fii:��5if2'_c?�t?�:::iTei!te:?u��_•�:::::::::::::q::_ ::v::::::::::::;:v ::::q:Fn cgpe?ii��:�•-_:fE'r.F?C:?_:L?_:i'_'_iFF'iiFSEEc IE.rye�••E�•[ .-. . ._ i_-'ry--c;_°__ _DE:�:'4.:. AE 'i[�__ '[.n_::ji:.'}'.�..:7'.i_ 7y .i: IIFIT.'E7'." `L's..._L -Y.i_i_L'�Yi!¥:'kF:9-9 :i..V00AJ"y" ?�'rt1L'44 3. L3' -i. .". i:'A'3_YTR:i:EE.".3H1iy""'ail?�ie 9i ii;:iiingii i; iii:E:_5.::i:i2i_:!F li�•[��-77•��/.�:''��::77-��77--"..":�-}}^^?'.:.x];_T[:-_-iiiiii"[_��'-�'i:�-:�_s:._.__..,..:ii-7:i:-V:ECEiiiiE:'.._:_:_�.:•.[_._._..:?:._[_�..iEEiti_..:"..�_...._}.-}5��i'7��i"�.:4.- .t,...:._..{.'{;?iEi-:}-�:-._.i9ii:� ".:'-�::}ii5:-{��:�-'�.�::�:�-c?�nSii� wry__icii(iF.ii�i Fr: PROy T$T"NSiii_C:.'RFF.�':LI�Y� =iiiCONTACT .'..'.is AIR O.EIN:Sii:'::ie_i Fi^�iSY.=is3 iiS2."{.]'MI ALSEi ti S Iiii�i f [ 1 1.:..::...__,...:..........:....::-__._...:....�a:::�__.::_:��:::..,:......:...__.;....:..::.,_-.....:i3:?'F:ii:_t!i_5:3�:�a:i��_:::-:-�:-:?:=��;��-�:iii:_�_'�;-ie'_�_ i: ��i� :� _ � �:��i�iii_ �r:;si `: :.� ��.. .:E_ :IN'u4_' _ .y��y'�::.++.xx: ... n._n._:•_:.;:='_R!c2 R —_:_ :r,c-;:_c::i.Ci:i7i'::d':::!:1!'i_i::::ii:'=:_fii iE i:.:::: 'i�_ii-i?___.�...:->:: •: T�O � OR•,- §'i��LaEkS[��::..r::�r::: .:::�x::::�:::;:•:: •:::::::s:•: :::::�:•: ::::::::::::•::•�r:::::.:::r-:::r:::::::a::::::r:::•::r..::::.:::.::.:•:r.:�:.:::-��:u., I::::: :::::::°::::::_;=J:::ii :iii2: iii.=-ii_:iiie' :iiiE3�i_iEiiFiiel�:cFi F iFES?eiEii i"i:ct°_ie:-k: t:i:i =: ii' c:°EFiSi�:ETriti::iciiEi F__ii itii i:iiiEiiF:i:5iSiia�iicE:ii_icu?iiiiii?� v: iio:iiii::HHi:.i:r:::: :::::::::e:i:i:.iiii<e":E -i_(ii v'EIn i'� ii'_: _ iii ::::::S: 5' :: �: :i ii- ':{ii ::?kii =i_::5:?" :[iiii:ii''ii-ii�: ' ! ::::"c:::'- - -i iii ri�i�r.:i ici:-:=c'.'"::6.:'iicE z""ii�-:'a c= :ui'': i :-::c ::ii-_?i iii f:_cii:::.::::E WE APPRECIATE YOUR BUSINESS.