Orange County NC Website
Browse       Search
POLICY NUMBER: <br />COMMON POLICY DECLARATIONS <br />POLICY PERI OD:FROM TO <br />AT 12:01 A.M. STANDARD TIME AT YOUR MAILI NG ADDRESS SHOWN ABOVE. <br />BUSINESS DESCRIPTIO N <br />IN RETURN FOR THE PAYMENT OF THE PREMIUM,AND SUBJECT TO ALL THE TERMS OF THIS <br />POLICY, WE AGREE WITH YO U TO PROVI DE THE INSURANCE AS STATED IN THIS POLICY. <br />THIS POLICY CONSISTS OF THE FOLLO WING COVERAGE PARTS FO R WHICH A PREMIUM IS <br />INDICATED.THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT. <br />PREMIUM <br />IL DS 00 09 08 <br />NAMED INSURED: <br />MAILING ADDRESS: <br />Page of <br />PREVIOUS POLI CY NUMBER: <br />COMPANY NAME PRODUCER NAME <br />Copyright, CM Insurance, 2019 <br />Includes copyrighted material of Insurance Services <br />Office, Inc. with its permission. <br />1 4 <br />CHURCH MUTUAL INSURANCE COMPANY, S.I. <br />3000 Schuster Lane <br />Merrill, WI 54452 <br />DocuSign Envelope ID: 77953783-C404-4AD0-84BA-D739A58B1A83