Orange County NC Website
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DocuSign Envelope ID: 3FD37DED-3EFC-49BB-BD08-D6EFCA4FEB76 <br /> rkl North Carolina Workers' Compensation Insurance Plan <br /> Beiz;y Riverport Insurance Company NCCI Carrier Code 27995 <br /> Administered by Berkley Assigned Risk Services <br /> ASSIGNED RISK SERVICES P.O. Box 59143, Minneapolis, Minnesota 55459-0143 <br /> Toll Free(888)548-7431 Fax(866)215-8118 <br /> www.berkleyassignedrisk.com policyservices @berkleyrisk.com <br /> ENTITY AND LOCATION SCHEDULE <br /> 1. The Insured: WCIP Policy Number: WC-32-90-415265-04 <br /> Risk ID: <br /> Senior Care of Orange County <br /> PO Box 8181 AtEn Health Center Tax ID#: <br /> Hillsborough, NC 27278 <br /> Policy Period: From: 21812075 <br /> To: 218/2016 <br /> Indorsement Eff. Date: 2/8/2015 <br /> Date of Mailing: 117!2015 <br /> Entity Information: <br /> Insured Name: Senior Care of Orange County Individual L Partnership <br /> Federal ID Number: F 56-2460614 [X]Corporation Other <br /> UIC Number: <br /> 105 Meadowland Dr <br /> Hillsborough, NC 27278 <br /> Agency Name and Address <br /> BB&T Ins Services Inc <br /> 414 Gallimore Dairy RD Ste F <br /> Greensboro, NC 27409 <br /> WC990601 <br />