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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 />Caldwell Fire Department lnc <br />7020 Guess Rd <br />Rougemont, NC 27572 <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 />CLTENT NUMBER: 0'166 <br />COVERAGE PERIOD FROM: 7 l1 l?025 TO 7 t1 t2026 <br />EMPLOYER LIABILITY LIMITS: <br />AUTHORIZED AGENT: <br />DATE:81712025 <br />$100,000 <br />$500,000 <br />$100.000 <br />Each Accident <br />Disease-Policy Limit <br />Disease-Each Employee <br />0,2 <br />l<b--z-7_. <br />Volunteer Safety Worker's Compensation Fund <br />3OO GALLERIA OFFICE CENTRE, SUITE 2OO <br />SOUTHFIELD, MI 48034 <br />AGENCY: <br />Herring & Bickers lnsurance Agency <br />PO Box 1559 <br />Hillsborough, NC 272780000 <br />Ilt(t%* <br />Docusign Envelope ID: 98CFD7CD-5E86-4B80-B3CD-3F09E1F5D0CF