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DocuSign Envelope ID:338AOB8C-3AC3-4BAB-B6D6-CAFDD9447473 <br /> NORTH CAROLINA FARM BUREAU MUTUAL INSURANCE COMPANY, INC. <br /> CERTIFICATE OF LIABILITY INSURANCE <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: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must he endorsed.If SUBROGATION IS WAIVED,subject <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 <br /> the certificate holder in lieu of such endorsement(s). <br /> INSURED DOUG MALINOWSKI JR CERTIFICATE ORANGE COUNTY PLANNING AND <br /> NAME AND 1G05 DIMMOCKS MILL ROAD HOLDER INSPECTIONS DEPT <br /> ADDRESS HILLSBOROUGH NC 27278 131 W MARGARET LANE <br /> PO BOX 8181 <br /> HILLSBOROUGH NC 27278 <br /> CSANDT7a ORANGECOUNTYNC.GOV <br /> COVERAGES _ <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> i <br /> INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> H TYPE OF INSURANCE AML SUBR POLICY NUMBER POLICY EFF POLICY ERP LIMITS <br /> MMFDDIYYYY° MMOD{YYYY <br /> ® COMMERCIAL GENERAL LIABILITY X GL 0483161 212312018 2/23/2019 GENERAL AGGREGATE _$2,000,000 <br /> OCCURRENCE PRODUCTS-COMPIOPS <br /> AGGREGATE $0 <br /> GEN`L AGGREGATE APPLIES PER POLICY PERSONAL&AOV INJURY $1,000,000 <br /> EACH OCCURRENCE $1,000,000 <br /> DAMAGE TO RENTED <br /> PR MI _ L $1 D0-_0—D_-O <br /> _ _�cr ---, - <br /> - <br /> MED EXP(Any one person) s5,000 <br /> ❑ EACH OCCURRENCE $ <br /> BUSINESSOWNERS <br /> AGGREGATE $ <br /> COMBINED SINGLE LIMIT I <br /> AUTOMOBILE LIABILITY (Each accident) <br /> $500,000 <br /> $12412018 2/2412019 BODILY INJURY{Per person] $ <br /> BAP 2177023 r <br /> SCHEDULELIAUTOS I <br /> ❑ HIRED AUTOS BODILY INJURY(Peraccided) $ 4 <br /> NON-OWNED AUTOS PROPERTY DAMAGE $ <br /> _IPer accident) _ __ <br /> ® GARAGE LIABILITY <br /> ❑ (Other) <br /> EACH OCCURRENCE $ <br /> ❑ EXCESS LIABILITY— <br /> OCCURRENCE AGGREGATE $ y <br /> ® <br /> We STATUTORY <br /> WORKERS COMPENSATION uMrrs <br /> AND EMPLOYERS'LIABILITY <br /> WC 0253741 8/2812018 8/28/2019 E.L.EACH ACCIDENT $100,000 <br /> E,L.,DISEASE-EA EMPLOYEE $100,000 <br /> POLICY APPLIES TO THE WORKERS ... ..___._ <br /> COMPENSATION LAW IN THE STATE OF NC E.L.DISEASE-POLICY LIMIT $500,000 <br /> OTHER: <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS E VEHICLES: Orange County is included as Additional Insured <br /> CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED AUTHORIZED REPRESENTATIVE <br /> BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE �J <br /> DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. DATE 9113/2018 { <br /> Cal 0910 <br />