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DocuSign Envelope ID:AA090EE8-66C2-4C49-8A7F-E6578EE85BD7 <br /> NORTH CAROLINA <br /> DEPARTMENT OF INSURANCE <br /> A"SFMRisk Management <br /> Wayne Goodwin, Commissioner of Insurance <br /> Rick McIntyre,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: 07/01/2016 until 06/30/2017 <br /> Coverage: A) Tort Claims against Departments, Agencies, and Employees <br /> B) Excess Liability for State Employees <br /> Lexington Insurance Company - Policy# 01-529-45-49 <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: 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 /> Verified By: <br /> Margie Boyd <br /> Risk Manager <br /> NCSU — 2016-17 (WC) <br /> 1202 Mail Service Center Raleigh, NC 27699-1202 1 www.ncdoi.com/osfm I tel: 919.661.5880 fax: 919.662.4416 <br /> An Equal Opportunity Employer CA <br />