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DocuSign Envelope ID:83CE5186-90BD-4376-8343-3887BADA96CD <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($),AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT:If the eertlfacate holder is an ADDITIONAL INSURED,the policy(ies)must be 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 Linda B Roberts CERTIFICATE Orange County <br /> NAME AND SBA J V Brockwell HOLDER P D Box 8181 <br /> ADDRESS 88821 Old NC 86 Hlllsbsrough NC 27278 <br /> Chapel Hill NC 27516 <br /> i <br /> I <br /> COVERAGES <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BE=LOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION Or 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 /> X TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MPOL,CY EFF POOLICOY EXP LIMITS <br /> COMMERCIAL GENERAL LIABILITY GL 0522126 4!512018 41512099 GENERAL AGGREGATE $2.0 00 000 <br /> -OCCURRENCE PRODUCTS-COMP/OPS <br /> AGGREGATE $2,000,000 <br /> GEN'L AGGREGATE APPLIES PER POLICY PERSONAL BADV INJURY $1 0Q0 000 <br /> EACH OCCURRENCE $1,000,000 <br /> DAMAU;L TO RENTED $100,000 <br /> MED EXP(Any one person) $5,000 <br /> ❑ <br /> suslNESSOWNERs EACH OCCURRENCE $ <br /> AGGREGATE $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000 000 <br /> I� BAP 2113218 4120/2018 10/2012018 (Each accident) { <br /> SCHEDULED AUTOS BODILY INJURY(Par persun) $ <br /> ❑ HIRED AUTOS BODILY INJURY(Per accident) $ III <br /> ❑ NON-OWNED AUTOS PROPERTY DAMAGE $ E <br /> El GARAGE accident <br /> CARAGE LIABILITY f <br /> © (Other) <br /> ❑ EXCESS LIABILITY EACH OCCURRENCE $ <br /> 1I <br /> OCCURRENCE AGGREGATE $ <br /> WC STATUTORY LIMIT S <br /> -- <br /> ❑ WORKERS COMPENSATION N/A E.L.EACH ACCIDENT <br /> AND EMPLOYERS'LIABILITY $ I <br /> POLICY APPLIES TO THE WORKERS E.I..DISEASE-FA EMPLOYEE $ <br /> COMPENSATION LAW IN THE STATE OFNC E.L.DISEASE-POLICY LIMIT $ <br /> OTHER: ! <br /> ❑ <br /> I <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES: <br /> I <br /> CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED AUTHORIZED REPRESENTATIVE <br /> BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE Robbie Norris <br /> DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, DATE 8130/2018 <br /> COI 0910 <br /> I <br />