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�I <br />Sedgwick James <br />Sedgwick James of the Carolinas <br />2000 Center Point Drive, Suite 2350, Columbia, South Carolina 29210, PO Box 21804, Columbia, South Carolina 29221 <br />Telephone 803 772 -1111, Telex 573462. Facsimile 803 772 -6361 <br />CERTIFICATE OF INSURANCE <br />NORTH CAROLINA <br />CERTIFICATE HOLDER: <br />COUNTY OF ORANGE, NORTH CAROLINA <br />132 EAST KING STREET <br />HILLSBOROUGH, N.C. 27278 <br />ROOFER: <br />CYCLONE ROOFING COMPANY <br />P.O. BOX 1279 <br />MATTHEWS, N.C. 28106 <br />RE: ORANGE COUNTY RECREATION CENTER <br />THIS IS - TO- CERTIFY THAT -THE. - ABOVE- ,_ROOFER.- _IS__A _QUALIFIED SELF-. <br />INSURER IN THE STATE OF NORTH CAROLINA THROUGH THE CAROLINAS <br />ROOFING & SHEET METAL CONTRACTORS SELF - INSURANCE FUND FOR THE <br />PERIOD OF JANUARY 1, 1992 TO DECEMBER 31, 1992 <br />THE FUND PROVIDES WORKERS COMPENSATION AND EMPLOYER'S LIABILITY <br />COVERAGE. EXCESS INSURANCE IS PROVIDED WITH THE FOLLOWING TERMS: <br />FUND POLICY <br />TYPE CARRIER POLICY RETENTION EXPIRATION LIMITS <br />SPECIFIC MIDWEST 4188 $500,000 JANUARY 1, COVERAGE A: <br />EXCESS EMPLOYERS SC -NC 1993 $5,000,000 <br />CASUALTY COVERAGE B: <br />$1,000,000 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND <br />CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE <br />DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE <br />POLICY LISTED ABOVE. <br />SHOULD THE ABOVE DESCRIBE POLICY BE CANCELED BEFORE THE EXPIRA- <br />TION DATE THEREOF, THE ISSUING COMPANY WILL MAIL THIRTY (30) <br />WRITTEN NOTICE TO THE ABOVE NAMED CERTIFICATE HOLDER. BUT FAIL- <br />URE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY <br />OF ANY KIND UPON THE COMPANY. <br />SEDGWI ES OF OU CAROLINA, INC. <br />BY: DATE: JANUARY 27, 1992 <br />Insurance Broking Risk Services Employee Benefits <br />