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DocuSign Envelope ID:6C6B4OBA-190D-4744-9248-ABA56D29933C <br /> 5 <br /> F <br /> NORTH CAROLINA FARM BUREAU MUTUAL INSURANCE COMPANY, INC. (I <br /> CERTIFICATE OF LIABILITY INSURANCE t <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:lithe certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed,If SUBROGATION IS WAIVED,subject k <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 s <br /> the certificate holder in lieu of such endorsement(s). z <br /> INSURED TORREY WHITE CERTIFICATE ORANGE PUBLIC TRANSPORTATION <br /> NAME AND 1649 WOODBROOKE DR HOLDER 600 NC HIGHWAY 86 N <br /> ADDRESS BURLINGTON,NC 27217 PO BOX 8181 <br /> HILLSBOROUGH,NC 27278 <br /> P <br /> } <br /> COVERAGES L, <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD r <br /> INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS a <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, g <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. !' <br /> r <br /> R TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY��EFpF�_� FpOpLK:yyi:) LIMITS p <br /> 1vYYY) (MM1UDDA WY) <br /> ® COMMERCIAL GENERAL LIABILITY INSO wvo GL 0524004 9/12/2017 9/12/2018 GENERAL AGGREGATE $300,000 <br /> -OCCURRENCE PRODUCTS-COMP/OPS <br /> AGGREGATE $ <br /> GENT.AGGREGATE APPLIES PER POLICY • PERSONAL&ADV INJURY $100,000 <br /> it <br /> EACH OCCURRENCE $100,000 - <br /> DAMAGE TO RENTED <br /> PREMISES(Ea Occurrence) $ <br /> MED EXP(Any one person) $5,000 P r, <br /> ❑ EACH OCCURRENCE $ <br /> BUSINESSOWNERS AGGREGATE $ ti <br /> U COMBINED SINGLE LIMIT $ <br /> AUTOMOBILE . (Each accident) <br /> ❑ SCHEDULED AUTOS. BODILYINJURY(Perperson) $ <br /> ❑ HIRED AUTOS ( ) $ t F. <br /> BODILY INJURY(Per accident <br /> ❑ NON OWNED AUTOS PROPERTY DAMAGE $ <br /> O (Per accident) <br /> GARAGE LIABILITY <br /> ❑ <br /> I(Other) <br /> EACH OCCURRENCE $ <br /> ❑ EXCESS LIABILITY— i <br /> OCCURRENCE AGGREGATE $ <br /> ❑ WORKERS COMPENSATION <br /> NIA WC STATUTORY LMITS ?`c' r F 1 <br /> AND EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ <br /> POLICY APPLIES TO THE WORKERS E.L DISEASE-EA EMPLOYEE $ <br /> COMPENSATION LAW IN THE STATE OF NC <br /> E.L.DISEASE-POLICY LIMIT $ l! <br /> OTHER: <br /> ❑ <br /> ift <br /> DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES: <br /> 5 <br /> li <br /> r <br /> 1 <br /> CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED AUTHORIZED REPR�SE.TA NE E• <br /> BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE <br /> DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, DATE 10/3/2017 / <br /> �, ti'L/�_ ti-J <br /> 1 <br /> COI 0910 <br /> 1 <br /> Is <br />