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WORKERS'COMPENSATION <br />CERTIFICATE OF COVERAGE <br />ISSUED BY OR ON BEHALF OF THE VOLUNTEER SAFETY <br />WORKERS'COMPENSATION FUND <br />NAME AND ADDRESS OF FUND PARTICIPANT <br />Orange Grove Volunteer Fire Company,Inc <br />6800 Orange Grove Rd <br />Hillsborough,NC 27278 <br />This company is a qualified self-insured in the state of North Carolina for its Workers' <br />Compensation liabilities pursuant to all statutory requirements under section 97-93 of the North <br />Carolina Workers'Compensation Act. <br />CLIENT NUMBER:0277 <br />COVERAGE PERIOD FROM:7/1/2025 TO 7/1/2026 <br />EMPLOYER LIABILITY LIMITS:$100,000 Each Accident <br />$500,000 Disease-Policy Limit <br />$100,000 Disease-Each Employee <br />AUTHORIZED AGENT: <br />DATE:8/7/2025 <br />Volunteer Safety Worker's Compensation Fund <br />300 GALLERIA OFFICE CENTRE,SUITE 200 <br />SOUTHFIELD,MI 48034 <br />AGENCY: <br />Business Insurers of the Carolinas Inc <br />501 Eastowne Dr.St.250 <br />Chapel Hill,NC 27514 <br />Docusign Envelope ID: CA1170BA-DF12-46AD-A715-3B43B21EAF28