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DocuSign Envelope ID: 167D3F94-AAC8-4BA4-B5EE-48724F55D42E <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 pollcy(les)must he endorsed.If SUBROGATION IS WAIVED,subject <br /> to the terms and condltlons of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to <br /> the cerflf7cate holder In lieu of such endomernent(s). <br /> INSURED WILLIE RICKY NEVVFON 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 ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED I3Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIM17S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> x TYPE OF INSURANCE A0151.51,1911 POLICY HUMMER POLICY EFP MPfH-lCY E11P LIMITS <br /> COMMERCIAL GENERAL LIABILITY GL 0525213 12/21/2016 1212112017 GENERALAGGREGATE $2 00D 000 <br /> -OCCURRENCE AAGGRREGGATTEeoIvIPacsPs $2,000,000 <br /> GEN'L AGGREGATE APPLIES PER POLICY PERSONAL A AOV INJURY $1 000 000 <br /> EACHOCCURRENCE $1,000,000 <br /> DAMAGE TO RENTED $100,000 <br /> . sliS_cea <br /> MED EXP(Any one pmon3 $5,000 <br /> BUSINESSOWNERS EACHOCCURRENCE $ <br /> AGGREGATE $ I <br /> C40MBINED SINGLE LIMIT $ l <br /> AUTOMOBILE LIABILITY (Each accldenl) <br /> SCHEDULEDAUTOS APM 4008513 8118l2017 2/1812018 BODILY INJURY(Per persan) $100,000 <br /> HIRED AUTOS BODILY INJURY(For wdow) $300,000 <br /> NON-OWNED AUTOS PROPERTYDAMAGE $250,000 <br /> Per acddenl <br /> ®'GARAGE LIABILITY <br /> (Other) <br /> D EXCESS LIABILITY-- EACH OCCURRENCE $ <br /> OCCURRENCE AGGREGATE $ <br /> VXUATUTORYL1mn-s .n, <br /> WORKERS COMPENSATION N1A AND EMPLOYERS!LIABILITY WC 0254248 12/21/2016 12/21/2017 E.L.eAeI1 ACCIDENT $100,000 <br /> E.L.DISEASE-EAEMPLOYEE $100,000 <br /> PCILIDYAPPLiESTO THE WORKERS <br /> COMPENSATION LAW&N"rHESTATE OF NC EL.DISEA$E-POLICY LIMIT $5Q0,000 <br /> OTHER: <br /> DESCRIPTION OF OPERATIONS!LOCATIONS 1 VEHICLES: <br /> CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED AUTHORIZED REPRESENTATIVE <br /> I3EFORETHE EXPIRATION DATE THEREOF,NOTICE WILL BE LINDAD.MARE <br /> DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. DATE 8/10/2017 i <br /> COI 0910 <br />