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i <br /> Gerald P Burke <br /> AMN PO Box 2905 <br /> A lit Tt( <br /> Hartford, CT 06104 -2905 <br /> Y." EL, ER <br /> December 01 , 2022 Phone : (610) 45 &2232 <br /> MEGAN SUMMERS Email : GPBURKE@travelers . com <br /> SUMMERS INSURANCE GROUP (OVM437) <br /> 2113 CAMERON ST STE 219 <br /> RALEIGH, NC 27605 <br /> This is a Direct Bill policy. The Direct Bill <br /> Account Number is 9862YA191 . <br /> i' <br /> This is the Policy Change for : CHARLES S BLACKWOOD <br /> 100 PINEWOOD DRIVE <br /> CHAPEL HILL, NC 27517 <br /> i` <br /> Bond Number : 106206426 <br /> Type of Bond ; Sheriff <br /> Obligee Name ; STATE OF NORTH CAROLINA <br /> Obligee Address : 3200 ATLANTIC AVENUE <br /> Obligee City, State & Zip : BRENTWOOD , NC 27604 USA <br /> Transaction Effective Date : December 01 , 2022 <br /> Premium Effective Date : December 01 , 2022 <br /> Premium Expiry Date : December 01 , 2026 <br /> Bond Limit ; $25, 000 . 00 <br /> Bond Premium : $ 0 . 00 <br /> Commission - Percentage : 30 % <br /> Special Commission : $ 0 . 00 <br /> i <br /> Countersignature Branch : <br /> Countersignature Commission : $ 0 . 00 <br /> State Tax : $ 0 . 00 <br /> State Surcharge : $ 0 . 00 <br /> TOTAL PREMIUM : $ 0 . 00 <br /> Comments : <br /> i <br /> Thank you for placing your business with us . <br /> Producer Name : SUMMERS , LARRY A <br /> i <br /> S4123 (9/96) Premium Evidence <br />