Orange County NC Website
DocuSign Envelope ID:AAB48FBD-7E41-49ED-AF28-FCE317917B07 <br /> CAROLINAS ROOFING AND SHEET METAL CONTRACTORS <br /> SELF INSURERS FUND <br /> Pickard Roofing Company, Inc. Date: 3/10/2016 <br /> P 0 Box76 <br /> Durham, NC 27702 Policy Number: CRSMC00057 <br /> Contact: Rena Carroll <br /> Telephone: 919.682.5702 <br /> WAIVER OF SUBROGATION INVOICE <br /> (Orange County/Old Courthouse Project) <br /> PAYROLL PAYROLL NC MANUAL <br /> CLASS DESCRIPTION AMOUNT RATE ASSESSMENT <br /> 5535 Sheet Metal Erection 0 $ 9.00 0 <br /> 5551 Roofing 12,750 $ 19.95 2,544 <br /> it <br /> TOTALS 12,750 2,544 <br /> X 5% <br /> Total Due $250 Minimum <br /> Mail Report& Payment To: <br /> CRSMC-SIF <br /> P O Box 63438 <br /> Charlotte, NC 28263-3438 <br />