|
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
<br />Original Printing Issued July 16, 2023 WC000001A
<br />INFORMATION PAGE
<br />Insurer.
<br />Markel Insurance Company
<br />10275 West Higgins Road
<br />Rosemont , IL 60018
<br />800-431-1270
<br />POLICY NO.
<br /> MWC0151790-05
<br />1.The Insured:
<br />Grow Your World
<br />Individual Partnership
<br />Corporation or X Nonprofit
<br />Mailing address:
<br />901 W Main St
<br />Carrboro , NC 27510-1510
<br />Other workplaces not shown above: See attached Location Schedule
<br />2.The policy period is from 07/01/2023 to 07/01/2024 at the insured's mailing address
<br />3.A. Worker Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states
<br />listed here: NORTH CAROLINA
<br />B.Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3 A. The limits of
<br />our liability under Part Two are:
<br />Bodily Injury by Accident $ 1,000,000 each accident
<br />Bodily Injury by Disease $ 1,000,000 policy limit
<br />Bodily Injury by Disease $ 1,000,000 each employee
<br />C.Other States Insurance: Part Three of the policy applies to the states, if any, listed here:
<br />AL, AK, AZ, AR, CA, CO, CT, DE, FL, GA, HI, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, NE, NV,
<br />NH, NJ, NM, NY, NC, OK, PA, RI, SC, SD, TN, TX, UT, VT, VA, WV and WI
<br />D.This policy includes these endorsements and schedules: WC000001A, WC990601, WC990602, WC990603,
<br />WC000000C, WC000308, WC000404, WC000406, WC000414A, WC000419, WC000421F, WC000422C,
<br />WC000424, WC000425, WC320301D, MJWC1000, MIL 1214, MPIL 1083, MPIL 1007 01 20
<br />4.The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to
<br />verification and change by audit
<br />Classifications Code
<br />No.
<br />Premium Basis
<br />Total Estimated
<br />Annual Remuneration
<br />Rate Per
<br />Remuneration
<br />Estimated
<br />Annual
<br />Premium
<br />Minimum Premium: $
<br />Total Estimated Annual Premium:
<br />Expense Constant
<br />Countersigned by
<br />WC000001A
<br />© 1987 National Council on Compensation Insurance
<br />*DOCID-56956748*
<br /> 008718-015088-56956748-07172023
<br />1 of 28 *MWC0151790-05*
<br />MWC0151790-05
<br />DocuSign Envelope ID: D5EE8B89-BEC9-47CA-86AA-BB69819758EC
|