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DocuSign Envelope ID: E47D81E7-73C7-4D81-B38C-A55633718062 <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 polley(ies)must be endorsed.If SUBROGATION IS WAIVED,subject <br /> to the terms and conditions of the policy,cerWn pollcles may re+qulre an endorsement A statement on this certificate does not confer rights to <br /> the certificate holder in lieu of such endorsement(s), i <br /> INSURED WILLIE RICKY NEVVrON CERTIFICATE ORANGE COUNTY <br /> NAME AND 403 GRADY ROAD HOLDER PO BOX 8181 <br /> ADDRESS CAMERON,NC 28326 HILLSBOROUGH, NC 27278 <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 /> INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF A14Y 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 SUaR POLICY NUMBER POLICY EFF POLICY EfP LIMITS <br /> 9F COMMERCIAL GENERAL LIA131LITY OL 0528213 12/2112016 12/21120/7 GENERALAGGREGATE $2,000,00,0 <br /> -OCCURRENCE PRODUCTS-CoMpioPS $2,000,000 <br /> GEN'L AGGREGATE APPLIES PER POLICY PERSONAL&ADV INJURY $1,000,000 <br /> EACHOCCURRENCE $1,000,000 <br /> DARAGETORENTED $100,000 <br /> NED LAP(Any ona ate+) $5,000 <br /> EACH OCCURRENCE $ <br /> BUSINESSOWNERS <br /> AGGREGATE $ <br /> (�® p LMT <br /> UTOMOBtLE LIABILITY t) $ <br /> SCHEDULEDAUTOS APM 4008513 811812017 2/1812018 BODILY INJURY(Per Pemm) $100,000 <br /> _ HIRED AUTOS— ---_--- SODILYINJURY(Pnfacrw,") $300,000 <br /> NON-OWNED AUTOS PR Erft DAAV�cE $250,000 <br /> GARAGE LIABILITY <br /> (Other) <br /> EACHOCCURRENCE $ <br /> [ EXCESS LIABILITY-- <br /> E)CCURRENCE AGGREGATE $ <br /> VCSTATUTORYUMIfS h s r <br /> WORKERS Ct7mpENSATION NIA nL � <br /> AND EMPLOYERS'LIABILITY WC 0254248 12121/2016 12/21/2017 E.L.EACH ACCIDENT $100,000 — <br /> E.L DISEASE-EAWPLOYEE $100,000 <br /> POLICY APPLIES FD THE WORKERS <br /> COMPENSATION LAW IN THE STATE OF NO E.L.DISEASE-POI ICY LIMIT 1$500,000 <br /> OTHER: <br /> Il <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES: <br /> CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED AUTHORIZED REPRESENTATIVE <br /> BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE LINDA D. MAKE <br /> DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. DATE 8/10/2017 <br /> COI 0910 <br />