2018-185-E Planning - Lake Orange spring mowing

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DocuSign Envelope ID: C067D335- DC9C- 40CB- 87BB- 8F884E2919E8 NORTH CAROLINA FARM BUREAU MUTUAL INSURANCE COMPANY, INC. CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING 1NSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must he endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement, A statement on this certificate does not confer rights to the certificate halter in lieu of such endorsement(s). INSURED DOUG MALINOWSKI JR CERTIFICATE ORANGE COUNTY PLANNING AND NAMEAND DBA WELLSMONT LANDSCAPING HOLDER INSPECTIONS DEPT ADDRESS 1740 JOHNSON ROAD 131 W MARGARET LANE BURLINGTON INC 272171 PO BOX 8181 HILLSBOROUGH NC 27278 CSANDT @ORANGECOUNTYNG.GOV THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 7I TYPE OF INSURANCE ADDLSUBR POLICY NUMBER MPOLIICY EFF MPOICY EXP LIMITS SP 21 COMMERCIAL GENERAL LIABILI X GL 0483161 2/23/2018 2/23/2019 GENERAL AGGREGATE $1000,000 I- OCCURRENCE PRODUCTS - COMPrOPS $0 EXCESS LIABILITY — EACH OCCURRENCE _ $ OCCURRENCE AGGREGATE $ WC STATUTORY LIMITS ® WORKERS COMPENSATION NIA AND EMPLOYERS'LIAt3ILITY WC 0253741 8124/2017 8124/2018 E.L. EACH ACCIDENT $100,000 POLICY APPLIES TO THE WORKERS E.L. DISEASE _EA EMPLOYEE $10(),000 COMPENSATION LAW IN THE STATE OF NC I E.L. DISEASE - POLICY LIMIT $5(] 0,0(}0 1 OTHER: DESCRIPTION OF OPERATIONS 1 LOCATIONS f VEHICLES: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE DATE 5/1612018 i ` 1 AGGREGATE GEN'L AGGREGATE APPLIES PER POLICY $1,000,'000 PERSONAL & ADV INJURY EACH OCCURRENCE $1,000,000 $100,000 DAMAGE TO RENTED PREMISES IEa Qgcuffenc _._ $5,000 MED EXP (Any one person) ❑ I EACH OCCURRENCE $ BUSINESSOWNERS AGGREGATE $ UTOMOBILE LIABILITY BAP 2177023 2124/2018 8124/2018 (E ®acd SINGLE LIMIT cchci t) $500,000 I k^a - SCHEDULEDAUTOS BODILY INJURY (Per person) $ ® HIRED AUTOS BODILY INJURY (Per accident) $ $ ® NON -OWNED AUTOS acda DAMAGE (PRer GARAGE LIABILITY - EXCESS LIABILITY — EACH OCCURRENCE _ $ OCCURRENCE AGGREGATE $ WC STATUTORY LIMITS ® WORKERS COMPENSATION NIA AND EMPLOYERS'LIAt3ILITY WC 0253741 8124/2017 8124/2018 E.L. EACH ACCIDENT $100,000 POLICY APPLIES TO THE WORKERS E.L. DISEASE _EA EMPLOYEE $10(),000 COMPENSATION LAW IN THE STATE OF NC I E.L. DISEASE - POLICY LIMIT $5(] 0,0(}0 1 OTHER: DESCRIPTION OF OPERATIONS 1 LOCATIONS f VEHICLES: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE DATE 5/1612018 i ` 1