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DocuSign Envelope ID:31076302-5D08-411F-A321-680354A900D1 <br /> North Carolina Farm Bureau Mutual Insurance Company, Inc. , <br /> Forms Schedule ' <br /> m <br /> Policy Number: IM 9727203 Endorsement Effective: 09/08/2018 <br /> Effective Date: 01/03/2017 Expiration Date: 01/03/2020 <br /> Named Insured: JOSEPH MARVIN PHELPS Agent: DALE DIXON <br /> Policy Forms Applicable To All Coverage Parts <br /> Form # Edition Description <br /> IMJNC 0309 Inland Marine Policy Jacket <br /> CL0100 0399 Common Policy Conditions <br /> CL0168 0101 Amendatory Endorsement— North Carolina <br /> CL0700 1006 Virus or Bacteria Exclusion <br /> IM2067 0906 Amendatory Endorsement <br /> FBIM43 1006 Amendatory Endorsement— Deductible and Appraisal Clause <br /> CL0600 0115 Certified Terrorism Loss <br /> CL0605 0115 Certified Terrorism Loss Disclosure of Premium and Federal Share of Insured Losses <br /> Policy Forms Applicable To Scheduled Property Floater <br /> Form # Edition Description <br /> FBIM41 1006 Scheduled Property Floater <br /> IMFS 0309 Page 1 of 1 <br />