Orange County NC Website
Browse       Search
DocuSign Envelope ID: DOD4336D-BBE2-4675-B7DF-226F5C0932F0 <br /> , <br /> 4 FARM NORTH CAROLINA FARM BUREAU <br /> BUREAU <br /> INSURANCE MUTUAL INSURANCE COMPANY <br /> • <br /> ,4 <br /> ca <br /> TELEPHONE(919)782-1705 P.O, BOX 27427 RALEIGH, NORTH CAROLINA 27611-7427 <br /> INSURANCE BINDER <br /> BINDER TERM: ONE YEAR FROM: 1/3/2017 TO: 1/3/2018 , <br /> s 12:01 A.M.STANDARD TIME AT THE RESIDENCE PREMISES <br /> NAMED INSURED AND MAILING ADDRESS: LIENHOLDER/MORTGAGEE <br /> s (No.,Street,Apt.,Town or City,State,ZIP Code) (Name and address) <br /> JOSEPH PHELPS <br /> i 1806 PATRICK HENRY LANE <br /> HILLSBOROUGH, NC 27278 <br /> POLICY#BINDER DALE DIXON <br /> ''TYPE OF COVERAGE: <br /> ❑ FARM FIRE ❑ CHURCH ❑ COMMERCIAL PROPERTY <br /> (please check) <br /> ti El INLAND MARINE ❑ BUSINESS OWNERS ❑ COMMERCIAL PACKAGE POLICY <br /> PERILS INSURED AGAINST: ❑ STANDARD ❑ BROAD ❑ NAMED PERILS ❑ ALL OTHER PERILS <br /> ❑ BASIC CI SPECIAL ❑ OTHER(Specify) <br /> ITEM AMOUNT OF DESCRIPTION OF <br /> ` NO. COVERAGE PROPERTY/SERIAL# LOCATION OF PROPERTY <br /> 2011 NEW HOLLAND RURAL: MI, OF ON <br /> 1 $ 27,000.00 TRACTOR ZCAE02556 SIDE OF CO. <br /> URBAN: ST. CITY <br /> NEW HOLLAND LOADER RURAL: MI. OF ON <br /> 2 $ 3,500.00 655TL SIDE OF CO, <br /> URBAN: ST. CITY <br /> 2014 LS TRACTOR MODEL RURAL: MI. OF ON <br /> 3 $ 30,000.00 4046, F00437 SIDE OF CO. <br /> `` URBAN: ST, CITY <br /> 2014 LS LOADER RURAL: MI. OF ON <br /> ¢ 4 $ 2,500.00 LL102 SIDE OF CO. <br /> ': URBAN: ST, CITY <br /> N Subject to Form No.(s) (Insert form numbers) <br /> TOTAL ANNUAL PREMIUM $ 378.00 <br /> UNDER NO CIRCUMSTANCES WILL THIS BINDER BE CANCELLED WITHIN THE TERM OF THE BINDER <br /> _'. EXCEPT UPON 10 DAYS'WRITTEN NOTICE TO THE MORTGAGEE/LIENHOLDER NAMED HEREIN. <br /> 68 4691 DALE DIXON <br /> --,- 4\ <br /> 7'COUNTY NO. AGENT N0. AGENT NAME <br /> 7— <br /> 919-732-2891 January 3, 2017 <br /> AGENT'S TELEPHONE NO, COUNTERSIGNATURE DATE ' AUTHORIZED SIGNATURE <br /> ;505023-001-0696 1 <br />