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PAGE 1 <br /> Ito-Owners WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY <br /> INSURANCE COMPANY ATTACHED TO AND FORMING PART OF <br /> 6101 ANACAPRI BLVD. , LANSING, MI 48917-3999 <br /> INFORMATION PAGE -RENEWAL AGREEMENT RENEWAL EFF. 06-17-2015 <br /> AGENCY HIGH & RUBISN INSURANCE AGENCY _ <br /> 15-0936-00 PO BOX 3040 (919) 913-1144 POLICY NUMBER <br /> ITEM 1 CHAPEL HILL NC 27515 MKT TERR 050 041715 35022549 <br /> INSURED ORANGE COUNTY LITERACY COUNCIL INC ITEM 2 POLICY PERIOD <br /> COMPANY FROM 12:01 A.M. 06-17-2015 <br /> ADDRESS 200 N GREENSBORO ST STE C2 BILL TO 12:01 A.M. 06-17-2016 <br /> CARRBORO NC 27510-1849 AT THE INSURED'S <br /> MAILING ADDRESS <br /> FED NUM 001 STATE NC <br /> FED ID <br /> ENTITY CORPORATION <br /> NUMBER OF EMPLOYEES 1 <br /> ORANGE COUNTY LITERACY COUNCIL INC <br /> 200 N GREENSBORO ST STE C2 <br /> CARRBORO NC 27510-1833 <br /> ISSUED 5-07-2015 <br /> 2762 (4-84) 1230 <br />