Orange County NC Website
Browse       Search
DocuSign Envelope ID: 23B19021- F3AC- 4D83- B621- FD21A11682EC <br />COMMERCIAL LINES CHANGE ENDORSEMENT <br />NORTH CAROLINA FARM BUREAU <br />MUTUAL INSURANCE COMPANY, INC. <br />p P.C. Box 27427 / Raleigh, North Carolina 27611 -7427 <br />Mutual Company <br />Named Insured and Mailing Address: <br />DOUG MALINOWSKI JR <br />DBA WELLSMONT LANDSCAPING <br />1005 DIMMOCKS MILL RD <br />HILLSBOROUGH, NC 27278 -7357 <br />Non Assessable Policy <br />Policy No: GL 0483161 Member ID Number: 1644652 <br />Policy Period: From 02/23/2018 To 02/23/2019 at 12:01 A.M. Standard Time at your mailing address shown above. <br />Effective Date of Change: 05/16/2018 Transaction # 003 <br />DESCRIPTION <br />NAMED INSURED IS AMENDED AS SHOWN ABOVE. <br />ADDITIONAL INSURED, ORANGE COUNTY PLANNING & INSPECTIONS DEPT IS ADDED AS REFLECTED ON THE <br />ATTACHED NAMED INSURED AND INSURABLE INTEREST SCHEDULE. FORM CG 2026 (ADDITIONAL INSURED - <br />DESIGNATED PERSON OR ORGANIZATION)IS REVISED AND ATTACHED. <br />WILL LAWS II, LUTCF <br />TELE: (919) 732 -7430 <br />110 MILLSTONE DR <br />HILLSBOROUGH, NC 27278 -8775 <br />Agent <br />CLCE 0913 <br />068 5538 <br />Agency No. <br />06/05/2018 <br />Countersignature Date <br />ADDITIONAL INSURED COPY <br />Authorized Representative <br />Page 1 of 1 <br />