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INSURANCE COMPANY OF NORTH AMERICA <br />40 A STOCK INSURANCE COMPANY <br />EXPIRING POLICY NO. NAP235540 <br />BUSINESS AUTO DECLARATIONS POLICY N0. CALe16653 <br />REFERENCE ID: PRODUCER BILLED PRODUCER NO. OAVP — 245228 <br />INCUSTRY CCDE: TF PIIC CCDE: 8321 MARKET HAZARD CODE: 2 <br />I TEMI ONE — BAS— COLUMB IA 9 MD . <br />NAMED INSURED: ORANGE CO— CI -APEL HILL RSVP(NCCH50) <br />ADDRESS: 410 CALDWELL ST, CHAPEL HILL NC.27514 <br />FORM OF BUSINESS: NON— PROFIT ORGANIZATION <br />NAMED INSURED'S BUSINESS: SOCIAL SERVICE AGENCY <br />POLICY PERIOD: POLICY COVERS FROM 7/01/90 TO 7/01/91 12:01 AM STANDARC <br />TIME AT THE NAMED INSURED'S ADDRESS STATED ABOVE <br />ESTIMATED TCTAL PREMIUM: S 36C.00 AUDIT PERIOD: NOT APPLICAELE <br />IN RETURN FCR THE PAYMENT OF PREMIUM AND SUBJECT TO ALL THE TERMS OF THIS <br />POLICY, WE AGREE WITH YOU TC PROVIDE THE INSURANCE AS STATED IN THIS POLICY. <br />(CONTINUED NEXT PAGE) <br />• <br />PAGE: 1 <br />9~L <br />OA -30387 (EC. 01/87) <br />CCPIES OF THIS DOCUMENT. HAVE BEEN SENT TO: INSURED PRODUCER S/C AUDIT <br />S/0 603 CAU -33280 BAS COMM.X15.0 ( NCCH50 -4 B 4/23/90 ) <br />