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DocuSign Envelope ID: 77AEB69E-2B0D-4l3F3-AB64-91 FD1 1A920E3 <br />(A <br />OSFM- <br />NC DEPARTMENT OF <br />INSURANCE <br />RISK MANAGEMENT <br />Tel 919.647.0000 Fax 919.715.0067 <br />MIKE CAUSEY, INSURANCE COMMISSIONER & STATE FIRE MARSHAL <br />BRIAN TAYLOR, ASSISTANT STATE FIRE MARSHAL <br />CERTIFICATE OF COVERAGE <br />Certificate Holder: To Whom It May Concern <br />Insurer: State of North Carolina <br />Authorization: Public Officers & Employee Liability Insurance Commission of North <br />Carolina and the General Statutes of North Carolina, Chapter 143, <br />Articles 31 to 31 D, Sections §143 -291 to §143 -300. <br />Period: July 1, 2017 until June 30, 2018 <br />Coverage: A) Tort Claims against Departments, Agencies, and Employees <br />B) Excess Liability for State Employees <br />Lexington Insurance Company - Policy # 01- 559 -22 -82 <br />C) Workers' Compensation <br />Limits A) $1,000,000 for Tort claims against the State <br />B) $10,000,000 for claims against state employees <br />C) Statutory Limits for Workers' Compensation <br />Description: North Carolina State University and its employees, officers, agents, as <br />covered by the Defense of State Employees as per NCGS § 143 300.2. <br />Administrator: Department Insurance - Risk Management Division <br />Public Officers & Employees Liability Insurance Commission <br />1202 Mail Service Center, Raleigh, NC 27699 -1202 <br />Note: <br />Verified By: <br />This Certificate is for informational purposes only and does not alter any <br />provision of the Tort Claims or Defense of State Employees General <br />Statutes of the State. <br />Margie Boyd <br />Risk Manager <br />OFFICE OF STATE FIRE MARSHAL <br />NCSU (2017 -18) <br />1202 MAIL SERVICE CENTER J RALEIGH, NC 27699 -1202 1 WWW.NCDOI.COM /OSFM <br />