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DocuSign Envelope ID: 23B19021- F3AC- 4D83- B621- FD21A11682EC <br />NORTH CAROLINA FARM BUREAU MUTUAL INSURANCE COMPANY, INC. <br />NAMED INSURED AND INSURABLE INTEREST SCHEDULE <br />Policy Number: GL 0483161 <br />Effective Date: 02/23/2018 <br />DOUG MALINOWSKI JR <br />DBA WELLSMONT LANDSCAPING <br />ADDITIONAL INSURED <br />MOFFAT PIPE INC <br />4901 UNICORN DR <br />WAKE FOREST, NC 27587 -5082 <br />CG2026 <br />Endorsement Effective Date: 05/16/2018 <br />Expiration Date: 02/23/2019 <br />NAMED INSURED SCHEDULE <br />INSURABLE INTEREST SCHEDULE <br />ADDITIONAL INSURED <br />ORANGE COUNTY PLANNING & INSPECTIONS DEPT <br />PO SOX 8181 <br />HILLSBOROUGH, NC 27278 <br />CG2026 <br />CNIS 0510 ADDITIONAL INSURED COPY Page 1 of 1 <br />