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DocuSign Envelope ID:OCB447B6-557A-44BE-A43B-987EO3ADAE3A <br /> PAGE <br /> WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY <br /> INSURANCE COMPANY 16144 <br /> 6101 ANACAPRI BLVD. , LANSING, MI 48917-3999 <br /> INFORMATION PAGE -RENEWAL AGREEMENT RENEWAL EFF. 06-17-2014 <br /> AGENCY HIGH 8 RUBISH INSURANCE AGENCY <br /> 15-0936-00 PO BOX 3040 (919) 913--1144 POLICY NUMBER <br /> CHAPEL HILL NC 27515 MKT TERR 050 041715 35022549 <br /> ITEM 1 <br /> INSURED ORANGE COUNTY LITERACY COUNCIL INC ITEM 2 POLICY PERIOD <br /> COMPANY FROM 12:01 A.M. 06-17-2014 <br /> ADDRESS 200 N GREENSBORO ST STE C2 BILL TO 12:01 A.M. 06-17-2015 <br /> CARRBORO NC 27510-1849 AT THE INSURED'S <br /> MAILING ADDRESS <br /> FEDERAL ID - <br /> NC EMPLOYER CODE - 08138060 <br /> COUNTY 068 <br /> A 1: CUMULATIVE MULTI-POLICY DISCOUNT APPLIES. SUPPORTING POLICIES ARE MARKED WITH AN (X) : <br /> COMM UMB( ) COMM PROP/COMM LIAB(X) COMM AUTO( ) LIFE( ) PERSONAL( ) FARM( ) . <br /> THE PAID IN FULL. DISCOUNT DOES NOT APPLY TO FIXED EXPENSE FEES, STATUTORY CHARGES OR <br /> MINIMUM PREMIUMS. <br /> THE PAID IN FULL DISCOUNT IS BASED ON FAVORABLE LOSS EXPERIENCE FOR THE COLLECTIVE GROUP <br /> OF POLICYHOLDER'S WHO CHOOSE TO PAY THEIR PREMIUM IN FULL DIRECTLY TO THE COMPANY. <br /> YOUR POLICY QUALIFIES FOR THE (PAID IN FULL DISCOUNT IF YOU CHOOSE TO PAY YOUR PREMIUM IN <br /> FULL. YOUR PAID IN FULL DISCOUNT MAY CHANGE AS A RESULT OF POLICY CHANGES. THESE CHANGES <br /> WILL BE REFLECTED IN A FUTURE INVOICE. <br /> TOTAL ESTIMATED ANNUAL PREMIUM 731 <br /> PAID IN FULL DISCOUNT 34- <br /> TOTAL POLICY PREMIUM IF PAID IN FULL 697 <br /> MINIMUM' PREMIUM $310 NORT14 CAROLINA <br /> AUDIT IS - ANNUAL <br /> END'OR'SEMENTS: <br /> 27011 (WC000308 ) 2703 (WCOOOOOOB) 27043 (WC320301C) 27279 (WCOO'0419 ) 27317 (WC000422A) <br /> 27322 (WC000421C) 27417 27942 (WC000414 ) <br /> YOU MAY VIEW YOUR POLICY ONLINE AT WWW.AUTO-OWNERS.COM . <br /> TO ENROLL, USE THE POLICY NUMBER 35022549 AND PERSONAL <br /> 11) CODE 78A 2N'8 63T. <br /> BILLING TYPE: COMPANY BILL - FULL PAY ACCOUNT 009652074 <br /> ISSUED 5-12-2014 <br /> 731 100 <br /> 27'177 (10-88)(WC000001A) AGENCY COPY 1415 <br />