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DocuSign Envelope ID: B0592255-65C9-4088-856C-ED399C645C1 D <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 policy(ies)must he 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 /> NAMEAND DBA WELLSMONT LANDSCAPING HOLDER INSPECTIONS DEPARTMENT <br /> ADDRESS 1005 DIMMOCKS MILL ROAD ENGINEERINGISTORMWATER DIVISION <br /> HILLSBOROUGH NC 27278 PO BOX 8181 <br /> HILLSBOROUGH INC 27278 <br /> CSANDT a@ORANGECOUNTYNC.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. i <br /> x TYPE OF INSURANCE ADOL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br /> MMID MMD <br /> ® COMMERCIAL GENERAL LIABILITY X GL 0483161 10/17/2018 10/17/2019 GENERAL AGGREGATE $2 000,000 <br /> -OCCURRENCE PRODUCTS-COMPIOPS <br /> AGGREGATE $0 <br /> GEN'L AGGREGATE APPLIES PER POLICY PERSONAL 8 ADV INJURY $1,000,DOO <br /> EACH OCCURRENCE $1,DOD,DOD <br /> DAMAGE TO RENTED $100,000 <br /> MED EXP[Any one person] $5,000 <br /> ❑ EACH OCCURRENCE $ <br /> BUSINESSOWNERS AGGREGATE $ <br /> AUTOMOBILE LIABILITY (Each COMBINED <br /> SINGLE OMIT $1,000,000 <br /> ® BAP 2177023 812412019 212412020 SCHEDULED AUTOS BODILY INJURY(Per Person) $ <br /> HIREDAUTOS BODILY I NJ U RY(Per acddenl) $ <br /> AROPERTYOAMAGE $ <br /> NON-OWNED AUTOS Per accident]__ _ <br /> GARAGE LIABILITY i <br /> � (Other) <br /> EgCHOCCURRENGE $1,000,000 <br /> M EXCESS LIABILITY— UP 7684782 11/20/2018 11/20/2019 AGGREGATE <br /> OCCURRENCE $ _ <br /> WC STATUTORY LIMITS <br /> ® WORKERS COMPENSATION NIP' <br /> AND EMPLOYERS'LIABILITY WC 0253741 812$12019 $12812020 E.L.EACH ACCIDENT $1,000,000 <br /> POLICY APPLIES TO THE WORKERS E.L.DISEASE-EA EMPLOYEE $1,DOO,OOO <br /> COMPENSATION LAW IN THE STATE OF NC E-L-DISEASE-POLICY LIMIT $1,0001000 <br /> OTHER: <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS!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 DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. DATE 811 912 01 9 &4 &_ <br /> COI 0910 <br />