Orange County NC Website
' ® OATE(MM/DD/YYYY) <br /> �►�Rn CERTIFICATE OF LIABILITY INSURANCE 07/17/2013 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. if SUBROGATION IS WAIVED, subject to <br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER NAMEACT Amy H.Paschal <br /> Ken B Lawson Jr. PHONE .919.846-2090 ext 105 ac No):919-846-2438 <br /> dba Lawson Insurance Group no Riess: aschaa nationwide.com <br /> 6512-101 Six Forks Rd. INSURERS AFFORDING COVERAGE NAIC# <br /> Raleigh, NC 27615 INSURER A: Nationwide Mutual Insurance Company <br /> INSURED INSURERS. EastGUARD Insurance Company <br /> ProNet Systems,Inc INSURER C: Progressive Southeastern Ins Company <br /> 3200 Glen Royal Road INSURER D: <br /> Suite 107 INSURER 5: <br /> Raleigh,NC 27617 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE AD L S R POLICY NUMBER MM ID EFF MM%1 DY EXP LIMITS <br /> LTR <br /> GENERAL LIABILITY ACP2252994383 2122/2013 02/22/2014 EACH OCCURRENCE $1000.00 <br /> X COMMERCIAL GENERAL LIABILITY PREMISES a o u ence $100,000 <br /> CLAIMS-MADE a OCCUR MED EXP(Any one person) s5,000 <br /> X Contractual Liability PERSONAL&ADV INJURY $1,000,000 <br /> X Contractors Enhancement GENERAL AGGREGATE s2 000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2.000,000 <br /> POLICY X PRO LOC $ <br /> AUTOMOBILE LIABILITY 07864851-2 (13101/2013 03/01/2014 EO aBIN 1SINGLE LIMIT $1,000,000 <br /> C ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> X AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE $ <br /> X HIRED AUTOS X AUTOS Per a 'dent <br /> $ <br /> X UMBRELLA LIAS X OCCUR ACP2252994383 2/22/2013 02122/2014 EACH OCCURRENCE s4,000,000 <br /> A X EXCESS LIAB CLAIMS-MADE AGGREGATE $4 OOO OOO <br /> DED I X I RETENTION#None I $ <br /> WORKERS COMPENSATION PRWC119466 0410312013 0410312014 X I wCSTATU- OTH- <br /> AND EMPLOYERS'LIABILITY <br /> B ANY PROPRIETORIPARTNERIEXECUTIVE YIN E.L.EACH ACCIDENT $500,000 <br /> OFFICER/MEMBER EXCLUDED? F N/A E.L.DISEASE-EA EMPLOYEE s500,000 <br /> (Mandatory In NH) <br /> If yes,describe under E.L.DISEASE-POLICY LIMIT S 500,000 <br /> DESCRIPTION OF OPERATIONS below <br /> A Business Services Bond 7900388862 7/11/2013 07/1112014 $50,000.Bond Limit <br /> 3rd Pa <br /> DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD till,Additional Remarks Schedule,if more space Is required) <br /> Orange County is included as additional insured where applicable per Contractors Enhancement Endorsement CG 72 88 attached. <br /> Waiver of Subrogation applies and is noted on the attached CG 7288. <br /> CERTIFICATE HOLDER CANCELLATION <br /> Orange County <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> P.O.Box 8181 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> Hillsborough,NC 27278 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> ATTN: Tammy Comar AUTHORIZED REPRESENTA <br /> E-Mail: tcomar @orangecountync.gov <br /> E-Mail: patfftronetsystemsinc.com <br /> c 1 88-2010 XCORD CORPORATION. All rights reserved. <br /> ACORD 25(2010/05){, 1 f----- ✓j v� ACORD name and logo are registered marks of ACORD <br />