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<br />MIKE CAUSEY <br />INSURANCE COMMISSIONER <br /> <br />BRIAN TAYLOR <br />STATE FIRE MARSHAL <br /> <br />OFFICE OF STATE FIRE MARSHAL <br />1202 MAIL SERVICE CENTER I RALEIGH NC 27699-1202 I TEL 919.647.0000 I Fax 866.851.6508 I WWW.NCOSFM.GOV <br /> <br />CERTIFICATE OF COVERAGE <br /> <br /> <br />Insurer: State of North Carolina <br /> <br /> <br />Authorization: North Carolina General Statute Sections 143-291 to 143-300.1A, <br />commonly referred to as the State Tort Claims Act. <br /> <br /> <br />Coverage: Tort Claims against Departments, Agencies, and Employees must be filed <br />in the North Carolina Industrial Commission and a legal defense is <br />provided by the State. <br />1. Workers’ Compensation <br /> <br />Limits $1,000,000 statutory damage to any one person arising out of any one <br />occurrence. NCGS § 143-299.2 <br />2. Statutory Limits for Workers’ Compensation <br /> <br />Description: University of North Carolina at Chapel Hill and its employees, officers, <br />agents, as covered by the Defense of State Employees as per NCGS § <br />143 300.2. The State Tort does not expire. <br /> <br />Administrator: Department Insurance - Risk Management Division <br /> Office of State Fire Marshal <br /> 1202 Mail Service Center, Raleigh, NC 27699-1202 <br /> <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 /> <br /> <br />Verified By: <br /> Latarsha Y. Silver, CRM <br /> Risk Manager <br /> <br />DocuSign Envelope ID: 4623A3A4-B651-4253-B823-7F4B270A7270