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4/25/2025 <br />Additional Information: Evidence of coverage. <br />Coverage B: <br />EMPLOYERS' LIABILITY $2,000,000 <br />Coverage C: <br />OTHER STATES WC-NO-402-24 StatutoryJuly 1, 2025July 1, 2024 <br />WC-NO-402-24 July 1, 2024 July 1, 2025 <br />By: Collin Klein, <br />Underwriter for the NCACC <br />Cancellation: Should any of the described coverage documents herein be cancelled before <br />the expiration date shown, the NCACC Pools will endeavor to mail written notice to the <br />Certificate Holder named herein, but failure to mail such notice shall impose no obligation <br />or liability of any kind upon the NCACC Pools, its agents or representatives, or the issuer of <br />this certificate. <br />CERTIFICATE HOLDER: <br />Orange County <br />PO Box 8181 <br />Hillsborough, NC 27278 <br />StatutoryCoverage A: <br />WORKERS' COMPENSATION July 1, 2025July 1, 2024WC-NO-402-24 <br />COVERAGES <br />Type of Coverage Coverage <br />Contract # <br />Effective <br />Date <br />Expiration <br />Date Limits <br />323 W. Jones St, Ste 500 <br />Raleigh, NC 27603 <br />WORKERS COMPENSATION COVERAGE CERTIFICATE <br />COVERAGE PROVIDER: <br />NCACC Workers' Compensation Pool <br />MEMBER: <br />323 West Jones St., Suite 500 <br />Raleigh, NC 27603 <br />This certificate is provided by the NCACC Joint Risk Management Agency <br />Workers’ Compensation Fund and is issued as a matter of information <br />only. This certificate confers no rights upon the certificate holder other <br />than those provided in the coverage document. This certificate does not <br />amend, extend, or alter the coverage afforded by the coverage <br />documents listed herein. <br />North Carolina Association of County Commissioners <br />Docusign Envelope ID: D6D62AFB-909E-46EC-8C86-95FD12C16692