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DocuSign Envelope ID:38BCD51C-7BFE-4270-B834-A7E30176DBE4 <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 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 /> 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 /> C SAN DT PORA NG E COU N TYNC.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 /> X TYPE OF INSURANCE ADDL SUER POLICY NUMBER LACY EFF POLICY EXPDfYYM LIMITS <br /> INS,® COMMERCIAL GENERAL LIABILITY X GL 0483161 10/17/2019 1 10/17/2020 1 GENERAL.AGGREGATE $2,400,000- <br /> -OCCURRENCE PRODUCTS-COMPIOPS <br /> AGGREGATE $0 <br /> GENT AGGREGATE APPLIES PER POLICY PERSONAL&ADV INJURY $1,000,000 <br /> EACH OCCURRENCE $1,000,000 <br /> DAMAGE TO RENTED $100 000 <br /> I:AALS�S_[E�2�aaQnsa}-.. <br /> MED EXP{Anyone persony $5,000 <br /> ❑ EACH OCCURRENCE $ <br /> 13USINESSOWNERS <br /> AGGREGATE $ <br /> AUTOMOBILE LIABILITY [Each lacdd nINGLE LIMIT $1,000,000 <br /> ® BAP 2177023 2/24/2020 8/24/2020 1 BODILY INJURY(Per person) $ <br /> SCHEDULED AUTOS <br /> HIRED AUTOS BODILY INJURY[Per accident] $ <br /> 1 <br /> ❑ f Per aE�ERTAMAGE <br /> D <br /> NON-OWNED AUTOS $ <br /> GARAGE LIABILITY <br /> ❑ (Other) <br /> ® EXCESS LIABILITY— EACH OCCURRENCE $1,000,000 _ <br /> OCCURRENCE UP 7684782 11/20/2019 11/20/2020 AGGREGATE $ <br /> ® WORKERS COMPENSATION NIA -WC STATUTORY LIMITS AND EMPLOYERS'LIABILITY WC 0253741 9/4/2019 9/4/2020 E.L.EACH ACCIDENT $1,000,000 <br /> POLICY APPLIES TO THE WORKERSE.L.DISEASE-EA EMPLOYEE $1,000,000 <br /> COIAPENSATION LAW IN THE STATE OF NC E-L.DISEASE-POLICY LIMIT $1,000,000 <br /> I OTHER: <br /> ❑ 4 <br /> i <br /> DESCRIPTION OF OPERATIONS!LOCATIONS 1 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 <br /> DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. DATE 3/26/2020 <br /> COI 0910 <br />