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.'',;::,N ;Vrh8�M.r.S.u^9;ti .w!64'24NOTi'r"?`:`-M'Aq.5�^J",�r�u�m'd_'^aYxMET.^9..:'i'W.14,70 7'm+74 rEMYS^.W?'..?'hf'„_:.1.w.. ,.,N✓..,^ :4;.; Ni.-011W:.. ....!J. ../o:::, , .. <br /> DocuSign Envelope ID:CDCEC775-C81E-44AD-AB72-5C4ADF26C195 <br /> MI-11 v,J J IU I I , .• <br /> C NORTH CAROLINA FARM BUREAU 'MUTUAL INSURANCE COMPANY PARTBDECLARATIONPAGE <br /> P.O.BOX 27427 RALEIGH,NORTH CAROLINA 27611-7427 PERSONAL AUTO POLICY <br /> POLICY RENEWAL DECLARATION - COVERAGE WILL <br /> EXPIRE ON 08/22/17 IF PREMIUM IS NOT PAID. <br /> 174 ; <br /> 1 <br /> 6 . r <br /> F�5L10� tVU�IIB�R::::� ......._. € :; ....:.::: T�....::..:.._ ���i��� ....:::: A��.hiT �: <br /> APM 8388077 08/22/17 02/22/18 2125827 APM DECL 0515 0195880 <br /> E- 1R Eke ANNA A .Ls :: iiiiiiiiiiiiiiiiii # <br /> DOROTHY CILENTI <br /> 238 TROUT LILY LN <br /> PITTSBORO, NC 27312-8483 DENISE MARTIN, FSCP <br /> TELE : (919) 542-2142 <br /> PO BOX 1030 54 '�---j ( _j <br /> PITTSBORO, NC 2 312 <br /> VEHICLES COVERED TYPE SYMBOL STATED <br /> VEH ZIPCD YR MAKE VEH SERIAL NUMBER CMP\COL OCN AMT. CLA SDIP <br /> 001 27312 05 TYTA CAMRY BASE PP 4T1BE32K35U576607 11\11 IB 00 <br /> 002 27312 10 NSSN ROGUE S AW PP JNBAS5MV8AW117183 14\14 1A 00 <br /> 003 27312 12 TYTA RAV4 PP JTMZF4DV7C5047035 18\18 1B 02 <br /> INSURANCE IS PROVIDED WHERE A PREMIUM IS SHOWN FOR THE COVERAGE . <br /> COVERAGE LIMITS OF LIABILITY PREMIUMS <br /> UNIT 1 2 3 <br /> A BODILY INJURY $ 100 , 000 EA PERSON $300 , 000 EA ACC 83 . 66 78 . 66 83 . 66 <br /> A PROPERTY DAMAGE $50 , 000 EACH ACCIDENT 59 . 66 56 . 66 59 . 66 <br /> D OTHER THAN COLLISION $ 100 DEDUCTIBLE 49 . 00 58 . 00 70 . 00 <br /> D COLLISION $500 DEDUCTIBLE 134 . 00 155. 00 <br /> TOTAL BY UNIT 192. 32 327 . 32 368. 32 <br /> C2 UNINS/UNDERINS MTR BI $ 100 ,000 EA PER $300 ,000 EA AC $64. 00 <br /> UNINSURED MOTORIST - PROPERTY DAMAGE $50 ,000 $4. 00 <br /> TOTAL TERM PREMIUM $955 . 96 <br /> • <br /> • <br /> THIS PREMIUM REFLECTS A FARM BUREAU DISCOUNT FOR THE FOLLOWING: <br /> -PREMIER -MULTICAR POLICY <br /> -PROPERTY COVERAGE WITH FARM BUREAU -FULL PAY PLAN <br /> -PROTECTION PLUS <br /> DRIVER: ID DRIVER NAME <br /> 01 DOROTHY CILENTI <br /> 02 LUCAS GRIFFIN <br /> 03 OLIVIA GRIFFIN <br /> PRU ,]S11NS CAREFULLY' Ct? TACT.... YO R AG NT. ..iP YI: AVE AN:Y ::: <br /> UES-TI OAS ._. RAES......:: ...- <br /> WE APPRECIATE YOUR BUSINESS. • <br /> • <br /> rE <br /> ri <br />