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DocuSign Envelope ID: E39A7F34-1956-4F98-91AB-121A6B293FOE <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,ANDTHE CERTIFICATE HOLDER. <br /> IMPORTANT:If the certificate 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 DOUG MALINOWSKI JR CERTIFICATE ORANGE COUNTY PLANNING& <br /> NAME AND DBA WELLSMONT LANDSCAPING HOLDER INSPECTIONS DEPARTMENT <br /> ADDRESS 1005 DIMMOCKS MILL ROAD ENGINEERING/STORMWATER DIVISION <br /> HILLSBOROUGH NC 27278 PO BOX 8181 <br /> HILLSBOROUGH NC 27278 <br /> C SAN DT@O RAN G ECOU N TY NC.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 /> 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 /> ]( TYPE OF INSURANCE ADDL SUBR POLICY NUMBER OLIC MPY Y F MPOO�LIICY LIMITS <br /> ® COMMERCIAL GENERAL LIABILITY X GL 0483161 10/17/2018 10/17/2019 GENERAL AGGREGATE s2,000,000 <br /> -OCCURRENCE PRODUCTS-COMPIOPS $� <br /> AGGREGATE <br /> GENT AGGREGATE APPLIES PER POLICY PERSONAL&ADV INJURY $1 P000,000 <br /> EACH OCCURRENCE $1,000,000 <br /> DAMAGE TG RENTED $100000 <br /> , <br /> PREMISES(Ea Occurrencsy- - <br /> MED EXP(Any one person) $5,000 <br /> ❑ EACH OCCURRENCE $ <br /> BUSINESSOWNERS AGGREGATE <br /> COMBINED SINGLE LIMIT $1 004 000 <br /> AUTOMOBILE LIABILITY (Each accident) <br /> ® BAP 2177023 8/24/2018 2/24/2019 BODILY INJURY(Per person) $ <br /> SCHEDULED AUTOS <br /> HIRED AUTOSBODILY INJURY(Per accident) $ <br /> PROPERTY DAMAGE $ <br /> NON-OWNED AUTOS Peraccidenl) <br /> GARAGE LIABILITY <br /> El (Other) <br /> EACH OCCURRENCE $1,000,000 <br /> ® EXCESS LIABILITY— UP 7684782 11/20/2018 11/20/2019 AGGREGATE $ <br /> OCCURRENCE <br /> WC STATUTORY LIMITS - <br /> ® WORKERS COMPENSATION NIA E-L.EACH ACCIDENT $1,000,000 <br /> AND EMPLOYERS'LIABILITY WC 0253741 812$l2018 8/28/2019 <br /> E.L.DISEASE-EAEMPLOYEE $1,000,000 <br /> POLICY APPLIES TO THE WORKERS <br /> COMPENSATION LAW IN THE STATE OF NO E.L-DISEASE-POLICY LIMIT $1,Od0,000 <br /> OTHER: <br /> El <br /> DESCRIPTION OF OPERATIONS!LOCATIONS 1 VEHICLES: ORANGE COUNTY IS INCLUDED AS ADDITIONAL INSURED <br /> ------------ <br /> CANCELLATION AUTHORIZED REPRESENTATIVE <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED <br /> BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE <br /> DELIVERED 1N ACCORDANCE WITH THE POLICY PROVISIONS. PATE 1J2512019 �lC �,{� <br /> ) <br /> COI 0910 <br />