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DocuSign Envelope ID:OCB447B6-557A-44BE-A43B-987E03ADAE3A <br /> Page 3 54643 (01-90) <br /> Issued 10-02-2014 <br /> (MUTUAL) INSURANCE COMPANY SUSINESSOWNERS POLICY DECLARATIONS <br /> 6101 ANACAPRI BLVD. , LANSING, MI 48917-3999 <br /> AGENCY HIGH '& RUBISW INSURANCE AGENCY Renewal Effective 11-20-2014 <br /> 15-0936-0'0 MKT TERR 050 (919) 913-1144 POLICY NUMBER 91-159-372-01 <br /> INSURED ORANGE COUNTY LITERACY COUNCIL INC Company Use 35-57--NC-9311 <br /> Company POLICY TERM <br /> ADDRESS 200 N GREENSBORO ST STE C2 Bill 12: 01 a.m. 12:01 a.m. <br /> CARRBORO NC 27510-1849 to <br /> 11-20-2014 11-20-2015 <br /> In consideration of payment of the premium shown below, this policy is renewed. Please attach this <br /> Declarations and attachments to your policy. If you have any questions, please consult with your agent. <br /> RATING INFORMATI0N <br /> Occupancy: Office Not Otherwise Classified Tenant Occupied <br /> Class Code: 65121 Const: Non-Combustible, S,prinklered <br /> Program: Office Protection Class: 03 <br /> Liability Rate Number: 00 Territory: 010 Orange County <br /> Burglary Rate Group: 00 Inside City Limits <br /> Construction Year: 1965 <br /> TOTAL ANNUAL PREMIUM TERM <br /> 5203.83 <br /> MINIMUM PREMIUM EQUIPMENT BREAKDOWN ADJUSTMENT $30.54 <br /> MINIMUM PREMIUM ADJUSTMENT $170.23 <br /> TOTAL POLICY PREMIUM $404.60 <br /> PAID IN FULL DISCOUNT -13.91 <br /> TOTAL POLICY PREMIUM IF PAID IN FULL $390 .69 <br /> The Paid In Full Discount does not apply to fixed fees or statutory charges. <br /> The Paid' In Full Discount is based on favorable loss experience for the collective group <br /> of policyholders who choose to pay their premiums in full directly to the company, <br /> Paid In Full Discount is available. <br /> Discount Applies for Affiliation with: CHAPEL WILL - CARRBORO CHAMBER OF COMMER <br /> A 4% Cumulative Multi-Policy Discount applies. Supporting policies are marked with <br /> an (X) : Comm Umb( ) Comm Auto( ) WC(X) Life( ) Personal( ) Farm( ) . <br /> Merit Rating Discount of 5% Applies <br />