HomeMy WebLinkAbout2025-439-E-Health Dept-UNC Healthcare System-BCCCP Mammogram ScreeningRevised 06/23
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[Departmental Use Only]
TITLE UNC BCCCP Program
FY 2025-2026
ORANGE COUNTY
UNC BCCCP PROGRAM CONTRACT
NORTH CAROLINA
THIS AGREEMENT, made and entered into this first day of July, 2025, (“Effective Date”) by and
between Orange County, North Carolina, a political subdivision of the State of North Carolina, (the "County"),
party of the first part; and UNC Health Care System (the "Provider"), party of the second part;
W I T N E S S E T H:
For the purpose and subject to the terms and conditions hereinafter set forth, the County hereby
contracts for the services of the Provider, and the Provider agrees to provide the following services to the
County in accordance with the terms of this Agreement, time being of the essence:
The services and/or materials (hereinafter referred to collectively as “Services”) to be furnished
under this Agreement are as follows: See Exhibit A "NC BREAST AND CERVICAL CANCER
PROGRAM" and Exhibit B "North Carolina Breast and Cervical Cancer Control Program 2025
Services Fee Schedule" and any amendments thereto, both of which are attached and hereby incorporated by
reference.
The term of this agreement rendered shall be from July 1, 2025 to June 30, 2026.
Provider represents and agrees that Provider is qualified to perform and fully capable of performing and
providing the services required or necessary under this Agreement in a fully competent, professional and timely
manner to the satisfaction of the County. Provider shall be responsible for all errors or omissions, in the
performance of the Agreement. Provider shall correct any and all errors, omissions, discrepancies, ambiguities,
mistakes or conflicts at no additional cost to the County. Provider agrees that Provider shall not sub-contract
any of the services to be provided in this Agreement, nor shall Provider assign any right or responsibility
granted or required by this Agreement, without the prior written approval of the County.
SPECIFIC TERMS
1. Payment: The County agrees to pay at the rates specified for Services satisfactorily performed
in accord with this Agreement. The amount to be paid by the County shall not exceed Four Thousand Five
Hundred Dollars ($4,500) and at the rate provided in Exhibit B and any amendments thereto. The County shall
monitor Services requested to limit Services to those that can be covered by the maximum amount stated in
this Agreement. Payment shall be made within thirty (30) days of an invoice properly submitted to County.
Should Provider fail to perform its duties under the terms of this Agreement, County may, without fault or
penalty, withhold any payment associated with the work to be performed until such time as said work is
completed.
2. Non–waiver: Failure by County at any time to require the performance by Provider of any of
the provisions hereof shall in no way waive or affect the County's right hereunder to enforce the same, nor
shall any waiver by the County of any breach be held to be a waiver of any succeeding breach or a waiver of
this Non-Waiver Clause.
3. Independent Contractor: The Provider shall operate as an independent contractor and the
County shall not be responsible for any of the Provider’s acts or omissions. The Provider shall not be treated
as an employee with respect to the Services performed hereunder for federal or state tax, unemployment or
workers' compensation purposes. The Provider understands that neither federal, nor state, nor payroll tax of
any kind shall be withheld or paid by the County on behalf of the Provider or the employees of the Provider.
Docusign Envelope ID: 5E743756-FAB9-4264-90BB-2E7F1176312C
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4. Insurance : Provider, an agency of the State of North Carolina, is responsible for its and its
employees' negligence as provided under North Carolina law. Provider shall maintain professional liability
self-insurance coverage sufficient to adequately insure itself during the performance of these services.
5. Indemnity: The Provider agrees to defend, indemnify, and hold harmless Orange County from
all losses, liabilities, claims, demands, suits, costs, damages or expenses (including reasonable attorney's fees),
to the extent provided by the North Carolina Tort Claims Act, arising from bodily injury, including death, to
any person or persons or damage to or destruction of any property caused in whole or in part by any negligent
or intentional act or omission on the part of the Provider, its agents, or assigns directly or indirectly related to
the Services to be performed pursuant to this Agreement on the part of the Provider.
6. Termination: This Agreement may be terminated at any time by mutual written agreement of
the parties or by the County upon written notice to the Provider. County may suspend this Agreement upon
reasonable notice to the Provider.
7. Entire Agreement and Signatures: The parties have read this Agreement and agree to be bound
by all of its terms, and further agree that it constitutes the complete and exclusive statement of the Agreement
between the parties unless and until modified in writing and signed by the parties. This Agreement together
with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto
evidence the intent of the Parties to comply with Article 11A and Article 40 of North Carolina General Statute
Chapter 66.
8. Priority: In determining the basic services to be provided, should any documents be referenced
in or attached to this Agreement, the terms of this Agreement shall have priority in any conflict between the
terms of referenced documents and the terms of this Agreement.
9. Governing Law: Both parties agree that this Agreement shall be governed by the laws of the
State of North Carolina. Provider shall at all times remain in compliance with all applicable local, state, and
federal laws, rules, and regulations including but not limited to all state and federal anti-discrimination laws,
policies, rules, and regulations and the Orange County Non-Discrimination Policy. Any violation of this
requirement is a breach of this Agreement and County may immediately terminate this Agreement without
further obligation on the part of the County. This paragraph is not intended to limit and does not limit the
definition of breach to discrimination. By executing this Agreement Provider affirms that Provider is and shall
remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. By executing this
Agreement Provider certifies that Provider has not been identified, and has not utilized the services of any
agent or subcontractor, on the list created by the State Treasurer pursuant to G.S. 147-86.58. By executing this
Agreement Provider certifies that Provider has not been identified, and has not utilized the services of any
agent or subcontractor identified, on the list created by the State Treasurer pursuant to G.S. 147-86.81.
10. Dispute Resolution: Any and all suits or actions to enforce, interpret, or seek damages with
respect to any provision of, or the performance or non-performance of, this Agreement shall be brought in the
General Court of Justice of North Carolina sitting in Orange County, North Carolina. It is agreed by the parties
that no other court shall have jurisdiction or venue with respect to such suits or actions. Binding arbitration
may not be initiated by either Party, however, the Parties may agree to nonbinding mediation of any dispute
prior to the bringing of such suit or action.
11. Non Appropriation: Provider acknowledges that County is a governmental entity, and the
validity of this Agreement is based upon the availability of public funding under the authority of its statutory
mandate.
If public funds are unavailable or not appropriated for the performance of County’s obligations
under this Agreement, then this Agreement shall automatically expire without penalty to County immediately
Docusign Envelope ID: 5E743756-FAB9-4264-90BB-2E7F1176312C
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upon written notice to Provider of the unavailability or non-appropriation of public funds. It is expressly agreed
that County shall not activate this non-appropriation provision for its convenience or to circumvent the
requirements of this Agreement.
In the event of a change in the County’s statutory authority, mandate or mandated functions,
by state or federal legislative or regulatory action, which adversely affects County’s authority to continue its
obligations under this Agreement, then this Agreement shall automatically terminate without penalty to County
upon written notice to Provider of such limitation or change in County’s legal authority.
Docusign Envelope ID: 5E743756-FAB9-4264-90BB-2E7F1176312C
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IN WITNESS WHEREOF, County and the Provider have signed this Agreement, effective as of
the day first written above.
PROVIDER
By: _________________________
Title: ________________________
UNC Health Care System
5221 Paramount Parkway, Suite 420
ORANGE COUNTY
By: _________________________
County Manager
300 W. Tryon St.
P.O. Box 8181
Hillsborough, NC 27278 Morrisville, NC 27560-5491
Scott Trott (Jul 14, 2025 10:22 EDT)
Scott Trott
System VP, Managed Care
Docusign Envelope ID: 5E743756-FAB9-4264-90BB-2E7F1176312C
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ORANGE COUNTY—INTERNAL USE ONLY
______________________________________________________________________________
Finance Information
Vendor Name: UNC Healthcare System Vendor Contact Person: Robin Morast Phone: 984-974-1279 Address: 5221
Paramount Parkway, Suite 420 City Morrisville State: NC Zip: 27560 Department: Health Amount: $4,500 Purpose:
BCCCP Mammogram Screening Budget Code(s): 10414020-631010-71401 Vendor # 30892
Vendor Status with NCSOS: Active-Current Vendor is a BOCC consultant: Yes No
Contract Details
Contract Type: New Amendment (Original Contract: ) (Most Recent Amendment )
Effective Date 7-1-25 End Date 6-30-26 Notice Date (Notice Purpose )
Award
Approved by Board (Agenda Date: 6/17/25); Made or Administered by
Signature Authority
- BOCC Express Delegation (Agenda Date: )
-Policy 9.4:Under $5,000; Service Under $90,000; Construction Under $250,000
- Budget Policy Section XV (Capital Improvement Project: )
Bidding
Informal Bidding ($30k-$90k); Formal RFP ($90k+); Other (<$30k); Exception(# )
Department Affirmation
This agreement is approved as to technical form and content and I as Department Director affirmatively state work on
this project has not been initiated prior to execution of the agreement.
Services related to this agreement have already begun or been completed. Description of the nature of the emergency
condition that was addressed:
Department Director’s Signature ________________________________________ Date: ________
Information Technologies
This agreement has been reviewed and is approved as to information technology content and specifications:
Office of the Chief Information Officer___________________________________ Date: ________
Inapplicable because no hardware/software purchases or related services
Risk Management
This agreement is approved for sufficiency of insurance standards, specifications, and requirements:
Office of the Risk Management Officer___________________________________ Date: _________
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act:
Office of the Chief Financial Officer ____________________________________ Date: _________
Legal Services
This agreement is approved as to legal form and sufficiency:
Office of the County Attorney __________________________________________Date: ________
Clerk to the Board
All Docusign contracts must be copied to the Clerk upon completion: occlerkdocs@orangecountync.gov
The following signature block is for hard copies only and is not required for Docusign contracts:
Received for record retention:
Office of the Clerk to the Board __________________________________________Date:_________
Docusign Envelope ID: 5E743756-FAB9-4264-90BB-2E7F1176312C
7/17/2025
7/21/2025
7/22/2025
7/22/2025
This Letter of Agreement between our respective organizations outlines the reimbursement terms
and conditions whereby UNC Faculty Physicians (UNC FP) will provide services related to breast
and cervical cancer screening for patients as referred by the Orange County Health Department
(OCHD). This letter will cover services provided on dates of service between July 1, 2025 and June
30, 2026. UNC FP shall comply with State regulations and local medical standards. For these
services, UNC FP agrees to accept as payment in full reimbursement rates as outlined on the “North
Carolina Breast and Cervical Cancer Control Program 2025 Services Fee Schedule” (Fee Schedule)
attached hereto as Exhibit B. Hospital services, if any, are excluded from this agreement, as are any
services provided by UNC FP that are not listed on the Fee Schedule. UNC FP further agrees to
seek payment only from the OCHD and will not seek payment from individual patients for services
covered under this agreement.
OCHD and UNC FP agree that UNC FP is an independent contractor and shall not represent itself as
an agent or employee of OCHD for any purpose in the performance of UNC FP’s duties under this
contract.
To the extent permitted by the NC Tort Claims Act, the UNC FP shall indemnify and hold harmless
the OCHD, its officials, agents, and employees from and against all claims, damages, losses, and
expenses, (including but not limited to fees and charges of attorneys and other professionals and costs
related to court action or arbitration) arising out of or resulting from the performance of this agreement
or the actions of the UNC FP or its officials, employees, or contractors under this agreement. This
indemnification shall survive the termination of this agreement.
UNC FP represents that it is in compliance with all applicable Federal, State, and local laws,
regulations or orders, as amended or supplemented. The implementation of this contract will be
carried out in strict compliance with all Federal, State, or local laws. If applicable, UNC FP shall
comply with HIPAA Privacy rules effective April 2003 and HIPAA Security regulations and
guidelines effective February 2005.
Either party may terminate this agreement by giving thirty (30) days written notice to the other
party.
OCHD will notify Hannah Little of patients being referred to UNC as part of this program.
Identification will occur preferably by email, or otherwise phone, to:
UNC Hospitals – Gynecology Oncology Clinic
Hannah Little
P (984) 215-5888
F (984) 974-9039
Hannah.little@med.unc.edu
Exhibit A
NC Breast and Cervical Cancer Program
Docusign Envelope ID: 5E743756-FAB9-4264-90BB-2E7F1176312C
2025 Office Fee
Code Fee Allowed
Clinical breast examination N/A Yes
77063 48.21$ No
77063TC 21.57$
77063-26 26.64$
77067 116.72$ No
77067TC 82.88$
77067-26 33.83$
Radiological examination, surgical specimen 76098 39.13$ No
76098TC 25.08$
76098-26 14.05$
Diagnostic mammography, unilateral, includes CAD 77065 114.35$ No
77065TC 78.61$
77065-26 35.75$
Diagnostic mammography, bilateral, includes CAD 77066 144.16$ No
77066TC 100.17$
77066-26 43.99$
G0279 40.72$ No
G0279TC 14.08$
G0279-26 26.64$
Ultrasound, complete examination of breast including axilla,76641 92.98$ No
unilateral (4)76641TC 60.42$
76641-26 32.56$
Ultrasound, limited examination of breast including axilla, 76642 77.29$ No
unilateral (4)76642TC 46.94$
76642-26 30.34$
Surgical evaluation/Consultation See Footnote (10)(10)Yes
Fine needle aspiration biopsy without imaging guidance, first lesion 10021 91.66$ Yes
Each additional lesion 10004 48.74$ Yes
Fine needle aspiration biopsy including ultrasound guidance, first lesion 10005 121.66$ Yes
Each additional lesion 10006 55.46$ Yes
Punch biopsy of skin (including simple closure when performed), single lesion 11104 111.67$ Yes
Each additional lesion 11105 53.89$ Yes
11106 138.80$ Yes
Each additional lesion 11107 63.69$ Yes
Puncture aspiration of cyst of breast 19000 88.16$ Yes
Puncture aspiration of cyst of breast, each additional cyst, used with 19000 19001 24.03$ Yes
Breast biopsy, with placement of localization device and imaging of 19081 441.20$ Yes
biopsy specimen, percutaneous; stereotactic guidance; first lesion (5)
Each additional lesion (5) 19082 334.48$ Yes
Breast biopsy, with placement of localization device and imaging of 19083 436.21$ Yes
biopsy specimen, percutaneous; ultrasound guidance; first lesion (5)
Each additional lesion (5)19084 327.95$ Yes
Breast biopsy, percutaneous, needle core, not using imaging guidance 19100 131.79$ Yes
Breast biopsy, open, incisional 19101 288.23$ Yes
North Carolina Breast and Cervical Cancer Control Program
Breast Cancer Screening and Diagnostic Procedures
2025 Services Fee Schedule (1)
For the Period 01/01/2025 through 12/31/2025 (Revision #3)
Screening digital breast tomosynthesis, bilateral (2)
Incisional biopsy of skin (e.g., wedge; including simple closure when
performed), single lesion
Screening
Follow-Up
Created: 01/14/2025; Revised 04/16/2025
Diagnostic digital breast tomosynthesis, unilateral or bilateral (3)
Screening mammography, bilateral, includes CAD
Exhibit BDocusign Envelope ID: 5E743756-FAB9-4264-90BB-2E7F1176312C
2025 Office Fee
Code Fee Allowed
Excision of cyst, fibroadenoma or other benign or malignant tumor, 19120 474.50$ Yes
aberrant breast tissue, duct lesion, nipple or areolar lesion; open;
one or more lesions
Excision of breast lesion identified by preoperative placement of 19125 522.93$ Yes
radiological marker; open; single lesion
Each additional lesion separately identified by a preoperative 19126 144.11$ Yes
radiological marker
Placement of breast localization device, percutaneous; mammographic 19281 218.11$ Yes
guidance; first lesion (6)
Each additional lesion (6)19282 152.38$ Yes
Placement of breast localization device, percutaneous; stereotactic 19283 231.94$ Yes
guidance; first lesion (6)
Each additional lesion (6)19284 166.29$ Yes
Placement of breast localization device, percutaneous; ultrasound 19285 320.22$ Yes
guidance; first lesion (6)
Each additional lesion (6)19286 258.95$ Yes
Needle biopsy of axillary lymph node 38505 156.71$ Yes
Ultrasonic guidance for needle placement, imaging 76942 54.28$ No
supervision and interpretation 76942-TC 25.97$
76942-26 28.31$
Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic 88172 52.10$ No
study to determine adequacy of specimen(s), first evaluation episode 88172TC 19.68$
88172-26 32.42$
Cytopathology, evaluation of fine need aspirate; immediate cytohistologic 88177 27.58$ No
study to determine adequacy of specimen(s), each separate additional 88177TC 7.79$
evaluation episode 88177-26 19.79$
Cytopathology, evaluation of fine needle aspirate; interpretation and report 88173 156.78$ No
88173TC 93.12$
88173-26 63.66$
Surgical pathology, gross and microscopic examination 88305 66.03$ No
88305TC 31.97$
88305-26 34.06$
Surgical pathology, gross and microscopic examination; requiring microscopic 88307 260.81$ No
evaluation of surgical margins 88307TC 186.27$
88307-26 74.54$
Morphometric analysis, tumor immunohistochemistry, per specimen; manual 88360 108.80$
88360TC 70.90$
88360-26 37.89$
Morphometric analysis, tumor immunohistochemistry, per specimen; 88361 106.04$
using computer-assisted technology 88361TC 66.41$
88361-26 39.63$
00400 19.63$
Moderate anesthesia, 10-22 minutes for individuals 5 years or older 99156 68.50$
Each additional 15 minutes (8)99157 53.11$
Anesthesia for procedures on the integumentary system, anterior trunk, not
otherwise specified (7)
2025 Services Fee Schedule (1)
North Carolina Breast and Cervical Cancer Control Program
Breast Cancer Screening and Diagnostic Procedures
Docusign Envelope ID: 5E743756-FAB9-4264-90BB-2E7F1176312C
2025 Office Fee
Code Fee Allowed
Pelvic examination - Bimanual N/A Yes
Cytopathology, cervical or vaginal, any reporting system, requiring 88141 23.00$
Cytopathology (liquid-based Pap test) cervical or vaginal, collected 88142 20.26$
in preservative fluid, automated thin layer preparation; manual
screening under physician supervision
Cytopathology, cervical or vaginal, collected in preservative fluid,88143 23.04$
automated thin layer preparation; manual screening and rescreening
under physician supervision
Cytopathology (conventional Pap test), slides cervical or vaginal 88164 18.19$
reported in Bethesda System, manual screening under physician
supervision
Cytopathology (conventional Pap test), slides cervical or vaginal 88165 42.22$
reported in Bethesda System, manual screening and rescreening under
physician supervision
Cytopathology, cervical or vaginal, collected in preservative fluid,88174 25.37$
automated thin layer preparation; screening by automated system,
under physician supervision
Cytopathology, cervical or vaginal, collected in preservative fluid,88175 26.61$
automated thin layer preparation; screening by automated system and
manual rescreening, under physician supervision
Human Papillomavirus, high-risk types (9)87624 35.09$ No
Human Papillomavirus, genotyping (9)87625 40.55$ No
Human Papillomavirus, reported high-risk types separately and pooled (9)87626 70.20$ No
Colposcopy of the cervix 57452 115.39$ Yes
Colposcopy of the cervix, with biopsy and endocervical curettage 57454 154.15$ Yes
Colposcopy of the cervix, with biopsy 57455 147.46$ Yes
Colposcopy of the cervix, with endocervical curettage 57456 138.27$ Yes
Surgical pathology, gross and microscopic examination 88305 66.03$ No
88305TC 31.97$ No
88305-26 34.06$ No
Surgical pathology, gross and microscopic examination; requiring 88307 260.81$ No
microscopic evaluation of surgical margins 88307TC 186.27$ No
88307-26 74.54$ No
Immunohistochemistry or immunocytochemistry, per specimen; 88342 102.06$
initial single antibody stain procedure 88342TC 70.60$
88342-26 31.46$
Immunohistochemistry or immunocytochemistry, per specimen;88341 87.51$
each additional single antibody stain procedure (List separately 88342TC 62.00$
in addition to code for primary procedure)88341-26 25.51$
Anesthesia for vaginal procedures (including biopsy of cervix) (7)00940 19.63$
Cervical Cancer Screening and Diagnostic Procedures
interpretation by physician
Follow-Up
Screening
2025 Services Fee Schedule (1)
North Carolina Breast and Cervical Cancer Control Program
Docusign Envelope ID: 5E743756-FAB9-4264-90BB-2E7F1176312C
CPT 2025
Code Fee
New patient; medically appropriate history/exam, straightforward decision- 99202 66.33$
making; 15-29 minutes
New patient; medically appropriate history/exam; low level decision-making; 99203 103.42$
30-44 minutes
Established patient; evaluation and management, may not require 99211 21.31$
presence of physician; presenting problems are minimal
Established patient; medically appropriate history/exam, straightforward 99212 52.17$
decision-making; 10-19 minutes
Established patient; medically appropriate history/exam; low level decision-99213 84.64$
making; 20-29 minutes
Established patient; medically appropriate history/exam; moderate level 99214 119.25$
decision-making; 30-39 minutes
Pelvic examination (list separately, in addition to primary procedure) (12)99459 19.17$
Administration of a standardized, evidence-based Social Determinants of G0136 17.42$
Health Risk assessment, 5-15 min., not more often than every 6 mos.
Community health integration services performed by certified or trained G0019 74.07$
auxiliary personnel, including a community health worker, under the
direction of a physician or other practitioner; 60 min./calendar year
Community health integration services, each additional 30 min./calendar year G0022 46.27$
Awaiting further guidance from NBCCEDP; fee schedule to be revised accordingly. (11)
determine their usage for your facility. The following are the codes and definitions that apply:
G = Global - the all-inclusive fee for performing and interpreting the service.
TC = Technical Component - the fee for performing the service.
26 = Professional Component - the fee for interpreting the service.
Global and Split Fees
Physician Visits
Telehealth Visits
Telephone Visits (11)
Office Visits (10)
North Carolina Breast and Cervical Cancer Control Program
2025 Services Fee Schedule (1)
Both global and split fees apply to the breast and cervical procedures listed on this fee schedule. The method and direction of payment will
Docusign Envelope ID: 5E743756-FAB9-4264-90BB-2E7F1176312C
(1)NC BCCCP covers only the physician's fee. Any facility charges associated with these CPT codes are not covered.
(2)
(3)
(4)Bilateral ultrasound may be reimbursed at one and one-half times the unilateral rate (not double unilateral rate).
(5)
(6)
(7)
(8)Example: If procedure is 50 minutes, code 99156 + (99157 x 2). No separate charge allowed if procedure <10 minutes.
(9)
(10)
(11)
(12)Code 99459 may only be reimbursed if cervical cytology (Pap) or HPV test is conducted during pelvic exam.
All consultations should be billed through the standard "new patient" office visit CPT codes: 99202-99205. Consultations billed
as 99204 or 99205 must meet the criteria for these codes, and must be pre-authorized. Codes 99204 and 99205 are typically not
appropriate for NC BCCCP screening visits, but may be used when provider spends extra time to do a detailed risk assessment.
BCCCP may pay for up to two surgical consultations.
Codes 19281-19286 are for image guidance placement of a localization device without image-guided biopsy. These codes should
not be used in conjunction with 19081-19084.
HPV DNA testing is not a reimbursable test for women under 30 years of age; 87626 cannot be reimbursed along with 87624
or 87625.
Fee is calculated using (Base Units + Time [in units]) x Conversion Factor = Anesthesia Fee Amount. Go to
https://www.cms.gov/medicare/payment/fee-schedules/physician/anesthesiologists-center for updated base rates and conversion
List separately in addition to 77065 or 77066.
List separately in addition to code for primary procedure 77067.
The National Breast & Cervical Cancer Early Detection Program (NBCCEDP) allows telehealth visits using regular office visit
codes through the end of December 2025. These visits can be performed using routine technology platforms (e.g., phones,
facetime, free Zoom, etc.) and relaxes the use of only HIPAA-compliant platforms. Future allowance for the use of telehealth
visits will be based upon guidance we receive from NBCCEDP. By law, NC BCCCP can only cover Medicare-approved and
allowable procedures.
NOTES:
Codes 19081-19084 are to be used for breast biopsies that include image guidance, placement of a localization device, and
imaging of specimen. They should not be used in conjunction with 19281-19286.
Docusign Envelope ID: 5E743756-FAB9-4264-90BB-2E7F1176312C
MIKE CAUSEY
INSURANCE COMMISSIONER
BRIAN TAYLOR
STATE FIRE MARSHAL
OFFICE OF STATE FIRE MARSHAL
1202 MAIL SERVICE CENTER I RALEIGH NC 27699-1202 I TEL 919.647.0000 I Fax 866.851.6508 I WWW.NC OSFM.GOV
February 19, 2024
Re: NC State Tort
The State of North Carolina, being self-insured and holding sovereign immunity, is not
susceptible to legal action without its explicit permission. Consequently, we do not procure
liability insurance. However, pursuant to statute (Chapter 143, Article 31), the State has
chosen to waive its sovereign immunity concerning suits related to the negligence of its
employees or agents, leading to injuries. The indemnity extends up to a maximum of
$1,000,000 for any single individual arising from a singular incident (NCGS § 143-299.2). The
North Carolina Industrial Commission is constituted as a court for the purpose of hearing and
passing upon tort claims against departments, institutions, or agencies.
The State tort is not attached to a policy, therefore does not expire, or require an expiration
date to be placed on the certificate of coverage.
We trust that the above information provides the necessary certification needed by your
organization. If you have any questions or need additional information, please let us know.
Sincerely,
Latarsha Y. Silver, CRM
Risk Manager
Docusign Envelope ID: 5E743756-FAB9-4264-90BB-2E7F1176312C
MIKE CAUSEY
INSURANCE COMMISSIONER
BRIAN TAYLOR
STATE FIRE MARSHAL
OFFICE OF STATE FIRE MARSHAL
1202 MAIL SERVICE CENTER I RALEIGH NC 27699-1202 I TEL 919.647.0000 I Fax 866.851.6508 I WWW.NCOSFM.GOV
CERTIFICATE OF COVERAGE
Insurer: State of North Carolina
Authorization: North Carolina General Statute Sections 143-291 to 143-300.1A,
commonly referred to as the State Tort Claims Act.
Coverage: Tort Claims against Departments, Agencies, and Employees must be filed
in the North Carolina Industrial Commission and a legal defense is
provided by the State.
1. Workers’ Compensation
Limits $1,000,000 statutory damage to any one person arising out of any one
occurrence. NCGS § 143-299.2
2. Statutory Limits for Workers’ Compensation
Description: University of North Carolina at Chapel Hill and its employees, officers,
agents, as covered by the Defense of State Employees as per NCGS §
143 300.2. The State Tort does not expire.
Administrator: Department Insurance - Risk Management Division
Office of State Fire Marshal
1202 Mail Service Center, Raleigh, NC 27699-1202
Note: This Certificate is for informational purposes only and does not alter any
provision of the Tort Claims or Defense of State Employees General
Statutes of the State.
Verified By:
Latarsha Y. Silver, CRM
Risk Manager
Docusign Envelope ID: 5E743756-FAB9-4264-90BB-2E7F1176312C
MIKE CAUSEY
INSURANCE COMMISSIONER
BRIAN TAYLOR
STATE FIRE MARSHAL
OFFICE OF STATE FIRE MARSHAL
1202 MAIL SERVICE CENTER I RALEIGH NC 27699-1202 I TEL 919.647.0000 I Fax 866.851.6508 I WWW.NCOSFM.GOV
CERTIFICATE OF COVERAGE
Insurer: State of North Carolina
Authorization: North Carolina General Statute Sections 143-291 to 143-300.1A,
commonly referred to as the State Tort Claims Act.
Coverage: Tort Claims against Departments, Agencies, and Employees must be filed
in the North Carolina Industrial Commission and a legal defense is
provided by the State.
1. Workers’ Compensation
Limits $1,000,000 statutory damage to any one person arising out of any one
occurrence. NCGS § 143-299.2
2. Statutory Limits for Workers’ Compensation
Description: University of North Carolina at Chapel Hill and its employees, officers,
agents, as covered by the Defense of State Employees as per NCGS §
143 300.2. The State Tort does not expire.
Administrator: Department Insurance - Risk Management Division
Office of State Fire Marshal
1202 Mail Service Center, Raleigh, NC 27699-1202
Note: This Certificate is for informational purposes only and does not alter any
provision of the Tort Claims or Defense of State Employees General
Statutes of the State.
Verified By:
Latarsha Y. Silver, CRM
Risk Manager
Docusign Envelope ID: 5E743756-FAB9-4264-90BB-2E7F1176312C