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DocuSign Envelope ID: F8416631-822D-444C-8COE-F530EA41841C <br /> HP 6229793 19614 COINSURANCE CONTRACT <br /> NORTH CAROL INA FARM BUREAU MUTUAL INSURANCE COMPANY PART 8 DECLARATION PAGE <br /> P.O.BOX 27427 RALEIGH,NORTH CAROLINA 27611-7427 HOMEOWNERS POLICY <br /> POLICY RENEWAL DECLARATION <br /> .......................... uiim <br /> ................. <br /> ........... ....................... <br /> t ......... .......... ..... . ........ <br /> ........... :Pa;;;;;;; <br /> ai .... .•. ... <br /> .............ROLI. Y.M.N.. ................- _Tla. .............................. .................... ................................. <br /> ...................... ........... ................... .. ....... memsEA. P. . . <br /> ....................................... .. ............_.. = :, ..............-.1........................................ ....................I-............. ........... .................. <br /> .................................................. .................. ............... ............. ........ .....................................................................I..............-1...................................... .......................... <br /> HP 6229793 10/28/18 110/28/191 09160851 .HO DECL 0913 0685730 <br /> ai;. ..............................................;...;............. ........................... <br /> ............................................ ..................................................;...........;.............. AGENTE. <br /> .NAMED,INSUREQ;At4D;;ADURES!S.'ii"i"i................. '--.-;__ -= -;. .................. <br /> ...........................-................ <br /> ........................ .. ................................................................................11..;.......... ...................................................... <br /> .... .................................................. .................................................. <br /> DWIGHT E COMPTON SR <br /> BETTY COMPTON <br /> 5900 COMPTON RD MATTHEW S DEITZ <br /> CEDAR GROVE, NC 27231-9353 TELE: (919) 732-7430 <br /> 110 MILLSTONE DR <br /> HILLSBOROUGH, NC 27278 <br /> ' TOTAL ANNUAL PREMIUM - - - - - - - - - - - - - *1 , 004 <br /> THE PREMISES COVERED BY THIS POLICY IS LOCATED <br /> 5900 COMPTON RD CEDAR GROVE NC 27231 ORANGE CNTY. <br /> RATING INFORMATION- AUTOMATIC VALUE-UP AT RENEWAL , FRAME, CONSTRUCTED IN 1891 , <br /> PRIMARY RESIDENCE, FIRE PROTECTION - CEDAR GROVE FD, PROTECTION CLASS 6, <br /> ANNUAL INCREASE IN SECTION I COVERAGES IS 4. 0%, TERRITORY 280 , <br /> HYDRANT WITHIN 1000 FEET, *1000 SECTION I LOSS DEDUCTIBLE, I FAMILY. <br /> COVERAGE AT THE ABOVE DESCRIBED LOCATION IS PROVIDED ONLY WHERE A LIMIT OF <br /> LIABILITY IS SHOWN OR A PREMIUM IS STATED <br /> SECTION I COVERAGE LIMIT OF LIABILITY PREMIUMS <br /> A. DWELLING *290 , 000 0733 <br /> B . OTHER STRUCTURES $29, 000 <br /> C. PERSONAL PROPERTY 4203, 000 087 <br /> D. LOSS OF USE *58, 000 <br /> SECTION II COVERAGE <br /> E. PERSONAL LIABILITY 01 ,000 ,000 EACH OCCURRENCE <br /> F . MEDICAL PAY. TO OTHERS 01 , 000 EACH PERSON 016 <br /> BASIC PREMIUM - - - - - - - - - - - - - 0836 <br /> ADDITIONAL PREMIUMS <br /> SPECIFIED ADD' L AMOUNT OF INSURANCE-COV A ONLY, HO-3220 *15 <br /> INCIDENTAL-FARM, HO-2472 *59 <br /> PERSONAL PROPERTY REPLACEMENT COST, HO-0490 *41 <br /> REFRIGERATED PROPERTY, HO-0498 *10 <br /> CREDIT FOR PROTECTIVE DEVICES, HO-0416 48CR <br /> OPTIONAL DEDUCTIBLE 051 <br /> ADDITIONAL PREMIUMS - - - - - - - - - - - - - 0168 <br /> .................... —------------—------ -----7............................................................. <br /> ............................ ...................................... ..................................................... ..........---------------------------- ................. <br /> ............ ..........m........... <br /> ........... ............... ............................... ..................................... <br /> .................................;:;..........m............ <br /> .................................... <br /> _2 <br /> .V <br /> .................................................. • <br /> ...................................................................................................... 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