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DocuSign Envelope ID: F7CD390C -D39C- 431E- 8BF1- 64E98FD291FE <br />FO 1451141 439 COINSURANCE CONTRACT <br />NORTH CAROLINA FARM BUREAU MUTUAL INSURANCE COMPANY PART B DECLARATION PAGE <br />P.D. BOX 27427 RALEIGH, NORTH CAROLINA 27611 -7427 FARMOWNERS POLICY <br />POLICY RENEWAL DECLARATION — COVERAGE WILL <br />EXPIRE ON 09/05/18 IF PREMIUM IS NOT PAID. <br />TOTAL ANNUAL PREMIUM — — — — — — -- — — — — — — $1,961 <br />THE PREMISES COVERED BY THIS POLICY IS LOCATED <br />5604 DAIRYLAND RD HILLSBOROUGH NC 27278 ORANGE CNTY. <br />RATING INFORMATION— 12 TOTAL ACRES, PRIMARY RESIDENCE --0012 ACRES, FRAME, <br />CONSTRUCTED IN 1900, TERRITORY 05, NUMBER OF FAMILIES -1, <br />$500 ALL OTHER PERILS LOSS DEDUCTIBLE, <br />$1000 WINDSTORM OR HAIL LOSS DEDUCTIBLE APPLIES TO COVERAGES A,B, <br />C FIRE PROTECTION — CANE CREEK FD, PROTECTION CLASS 06. <br />COVERAGE AT THE ABOVE DESCRIBED LOCATION IS <br />PROVIDED ONLY WHERE A <br />LIMIT OF <br />LIABILITY IS SHOWN OR A PREMIUM IS STATED. <br />COVERAGES <br />LIMIT OF LIABILITY <br />PREMIUM <br />A. RESIDENCE <br />$190,000 <br />$844 <br />B. RELATED PRIVATE STRUCTURES <br />$19,000 <br />INCL <br />C. PERSONAL PROPERTY <br />$133,000 <br />$76 <br />D. ADDITIONAL LIVING COSTS <br />$39,000 <br />$3 <br />L. FARM PERSONAL LIABILITY <br />$1,000,000 <br />M. MEDICAL PAY. TO OTHERS — PER PERSON <br />$5,000 <br />EACH ACCIDENT <br />$25,000 <br />TOTAL BASIC PREMIUM — <br />— -- — — — — — — — — — — <br />$923 <br />ADDITIONAL COVERAGES <br />COV. F — SCHEDULED FARM BARNS,BLDGS,STRUCTURES — FBP603 $1,043 <br />ADDITIONAL PREMIUMS <br />DEDUCTIBLE OPTION CHARGE /CREDIT $129CR <br />INITIAL FARM EXPOSURE $63 <br />REPLACEMENT VALUE — ML55 $46 <br />ANIMAL COLLISION — FBL08 $14 <br />L REFRIGERATED PROPERTY — FBP26 $10 <br />