Orange County NC Website
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DocuSign Envelope ID:456CB831-89E2-409B-8715-A71C362353A4 <br /> North Carolina Workers' Compensation Insurance Plan <br /> Berkley Riverport Insurance Co NCCI Carrier Code 27995 <br /> Administered by Berkley Assigned Risk Services <br /> P.O,Box 59143, Minneapolis,Minnesota 55459-0143 <br /> ASSIGNED RISK SERVICES Toll Froc(888)548-7431 Fax(866)215-8118 <br /> vvww.berkleyassignedrisk,COrn policyservices@borkleyrIsk,com <br /> ENTITY AND LOCATION SCHEDULE <br /> 1. The Insured: Policy Number: NCARP305328 <br /> Tax ID#: <br /> Senior Care of Orange County Policy Period: From: 02/08/2016 <br /> 105 Meadowlands Drive To: 02/08/2017 <br /> Hillsborough, NC 27278 Endorsement Date 02/08/2016 <br /> Date of Mailing: 01/08/2016 <br /> Entity information Effective Expiration <br /> Insured Name: Senior Care of Orange County February 8, 2016 February 8,2017 <br /> Federal ID Number: February 8, 2016 February 8, 2017 <br /> Entity Type: Corporation February 8, 2016 February 8, 2017 <br /> Location No. Location Address Effective Expiration <br /> 1 105 Meadowland Dr February 8, 2016 February 8,2017 <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 WC990601 <br />