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DocuSign Envelope ID:9F1BD1AE-AA3F-4F58-8FB2-A1C39A00321F <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(ias)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 GRANGE COUNTY <br /> NAME AND DBA WELLSMONT LANDSCAPING HOLDER PO BOX 8131 <br /> ADDRESS 1005 DIMMOCKS MILL RD HILLSBOROUGH NC 27278 <br /> HILLSBOROUGH NC 27278 <br /> abames@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,TERNS 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 /> H TYPE OF INSURANCE A D D L IUVBDR. POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br /> INSO (MMODWM <br /> ® COMMERCIAL GENERAL LIABILITY I GL 0483161 10/17/2018 10/17/2019 GENERAL AGGREGATE $2 000,000 <br /> OCCURRENCE I PRODUCTS-COMP/OPS AGGREGATE $0 <br /> GEN'L AGGREGATE APPLIES PER POLICY PERSONAL&ADV INJURY $1,000,QDO <br /> EACH OCCURRENCE $1,000000 <br /> DAMAGE TO RENTED -- <br /> $rj100 000 <br /> PREMISES a Qrg;gy � <br /> I -- <br /> MFD EXP(Any one person) $ 000 <br /> i <br /> EACH OCCURRENCE $ <br /> BUSINESSOWNERS <br /> AGGREGATE $ <br /> COMBINED SINGLE LIMIT $1 000 000 <br /> AUTOMOBILE LIABILITY (Each acOdent) <br /> ® BAP 2177023 02/24/2019 D812412 0 1 9 _.SCHEDULED AUTOS BODILY INJURY[Per person] $ <br /> FIRED AUTOS BODILY INJURY[Per accident] $ <br /> ❑ NON-OWNED AUTOS PROPERTYDAMkGE $ <br /> I Per accidents <br /> GARAGE LIABILITY <br /> I <br /> (Other) I <br /> ® EXCESS LIABILITY— E EACH OCCURRENCE $1,000,000 <br /> OCCURRENCE UP 7684782 11/20/2018 11/20/2019 AGGREGATE $ <br /> WC STATUTORY LIMITS <br /> ® AND EMRS PLOYERS <br /> LIABILITY <br /> IONILIT NSA WC 0253741 i 08/28/2018 08/28/2019 $1,000,000 <br /> AND EMPLOYERS'LIABII_,ITY E.L.EACHACCEDENT <br /> POLICY APPLIES TO THE WORKERS E.L.DISEASE-EA EMPLOYEE $1,000,000 <br /> COMPENSATION LAW IN THE STATE OF NC E-L.DISEASE-POLICY LIMIT <br /> $1,000,000 <br /> OTHER: <br /> Li <br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES: <br /> CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED AUTHORIZED REPRESENTA [V <br /> BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE r <br /> DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. DATE 07/17/2019 [I <br /> Col 0910 <br />