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DocuSign Envelope ID:26CB3394-9EF5-42C1-8EAB-432A9B415AA4 <br /> State Farm STATE FARM FIRE AND CASUALTY COMPANY Li <br /> " A STOCK COMPANY WITH HOME OFFICES IN BLOOMINcTON,ILLINOIS RENEWAL DECLARATIONS <br /> AIlanla A"Yns46-2117 Policy Number 93-10-D971-7 <br /> Named Insured Policy Period Effective Date Expiration Date <br /> 0-07-6379-FB5D F U 12 Months OCT 1 2015 OCT i 2016 <br /> 000704 3125 The policy period begins and ends at 12:01 am standard <br /> ANALYTICAL CONSULTANTS INC time at the premises location. <br /> 125 KINGSTON DR STE 206 <br /> CHAPEL HILL NC 27514-1649 <br /> Agent and Mailing Address <br /> �.. MICHELLE CARLISLE INS AGCY INC <br /> 200 TIMBERHILL PL UNIT 202 <br /> s <br /> CHAPEL HILL NC 27514.1964 <br /> PHONE: (919) 918-4478 <br /> • (919) 918-4479 <br /> N <br /> Q <br /> Office Policy <br /> Automatic Renewal-If the policy period is shown as 12 months,this policy will be renewed automatically subject to the premiums,rules and <br /> forms in effect for each succeeding policy period.If this policy is terminated,we will give you and the Mortgagee/Lienholder written notice in <br /> compliance with the policy provisions or as required by law. <br /> Entity: Corporation <br /> NOTICE: Information concerning changes in your policy language is included. Please call your agent <br /> if you have any questions. <br /> POLICY PREMIUM $ 475.00 <br /> Minimum Premium <br /> Discounts Applied: <br /> Renewal Year <br /> Years in Business <br /> Protective Devices <br /> Sprinkler • <br /> Claim Record <br /> 1 <br /> Prepared <br /> AUG 07 2015 ©Copyright,State Form Mutual Automobile Insurance Company,2008 <br /> CMP-4000 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. <br /> 004331 294 I Continued on Reverse Side of Page Page 1 of 7 <br /> E 02 <br /> 510-60613.2 05 31-2011(o113231c1 <br />