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DocuSign Envelope ID: B38F4611-6CFB-4CCB-9EF8-F272058BA03E <br /> CORRECTED 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 INSURERS),AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE 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 DEPT <br /> ADDRESS 1005 DIMMOCKS MILL RD ENGINEERINGISTORMWATER DIVISION <br /> HILLSBOROUGH NC 27278 csandt@orangecountync.gov <br /> PO BOX 8181 <br /> 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 BY THE POLICIESâť‘ESCHWED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.OMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> x TYPE OF INSURANCE ADDL SUBS POLICY NUMBER POUCYEFF POLICY F7LP UMn'S <br /> pD. <br /> X COMMERCIAL GENERAL LIABILITY X GL 0483161 10/17/2018 10/17/2019 GENERALAGGREGATE_ $2,000,000 <br /> -OCCURRENCE PRODUCTS-COMPIOPS $ <br /> AGGREGATE <br /> GEN'L AGGREGATE APPLIES PER POLICY PERSONAL&ADV INJURY 41,000,000 <br /> EACH DCCURREWE $1,000,000 <br /> DAMAGE TO RENTED $100r000 <br /> lldt5E5dEaLQ=rrwW <br /> MED ExP(Any on person) $5,000 <br /> EACH OCCURRENCE $ <br /> BU SI N ESSO W N ERS AGGREGATE <br /> AUTOMOBILE LIABILITY Each amGeMNGL£LIIu4Cf $1,000,000 <br /> X SCHEDULED AUTOS BAP 2177023 08/24/2018 02/24/201 9 BODILY INJURY(Per person) $ <br /> HIRED AUTOS BODILY INJURY(Per amieenq $ <br /> NON-OWNED AUTOS PROPERTY DAMAGE $ <br /> GARAGE LIABILITY <br /> (Other) <br /> EACH OCCURRENCE $1,000,000 <br /> - x IOCCURRENCE E <br /> XCESS LIABILITY- <br /> UP 7684782 1 11/20/2018 11/20/2019 f AGGREGATE <br /> $1,000,000 <br /> we STATUTORY LIMITS <br /> AND EMPLOYERS'LIABILfTY <br /> X WORKERS COMPENSATION NIA WC 0253741 10/17/2018 08/28/2019 E.L.EACH ACCIDENT $1'000'000 <br /> AND E <br /> E.F..DISEASE-EA EMPLOYEE $1,W0r000 <br /> POLICY APPLIES TO THE WORKERS <br /> COMPENSATION LAW IN THE STATE OF NC E.L.DISEASE-POLICY UMI7 $1,000,000 <br /> OTHER: <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS I 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 L.M.Squires <br /> DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. DATE February 1, 2019 <br /> col 0910 068-5538 TW <br />