Orange County NC Website
r ® DATE(MM/DD/YYYY) <br /> AC40R, ' CERTIFICATE OF LIABILITY INSURANCE <br /> 07/1712013 <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 /> E OW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> PRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> PORTANT: 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 aixc No): 919-846-2438 <br /> AIC dba Lawson Insurance Group ADDDARESS: aschaa nationwide.com <br /> 6512-101 Six Forks Rd. INSURERS AFFORDING COVERAGE NAIC# <br /> Raleigh,INC 27615 INSURERA: Nationwide Mutual Insurance Company <br /> INSURED INSURER B: EastGUARD Insurance Company <br /> PrONet Systems, Inc INSURER C: Progressive Southeastern Ins Company <br /> 3200 Glen Royal Road INSURER D: <br /> Suite 107 INSURERE: <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 ADDL SUBR POLICY NUMBER POLICY EFF /POLICY EXP LIMITS <br /> LTR <br /> -. GENERAL LIABILITY ACP2252994383 2/22/2013 02/2212014 EACH OCCURRENCE $110001000 DAMAGE PGEIP:LAOGGREGATE MERCIAL GENERAL LIABILRY PREM SES Ea occuErrence $100 000 <br /> CLAIMS-MADE I OCCUR MED EXP(Any one person $5 000 <br /> ntractual Liability PERSONAL&ADV INJURY $1 00O 000 <br /> ntractors Enhancement GENERAL AGGREGATE $2 000 000 <br /> LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2 00O 000 <br /> ICY X PRO- LOC $ <br /> t1TOMOBILE LIABILITY 07864851-2 03/0112013 03/01/2014 Ea accideDDSINGLE LIMIT $11,000,000 <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> X AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE $ <br /> • HIRED AUTOS .IX AUTOS Per accident <br /> • UMBRELLA LIAB X OCCUR ACP2252994383 2/22/2013 02/22/2014 EACH OCCURRENCE s4.000.000 <br /> A X EXCESS LIAB CLAIMS-MADE AGGREGATE s4,000,000 <br /> DED I X I RETENTION$None $ <br /> WORKERS COMPENSATION PRWC119466 4/03/2013 04/03/2014 X F TATU- OTH- <br /> AND EMPLOYERS'LIABILITY a <br /> B ANY PROPRIETOR/PARTNEEXECUTIVE E.L.EACH ACCIDENT $50U OOO <br /> OFFICER/MEMBER EXCLUDED? NIA <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 <br /> LA Business Services Bond 7900388862 07/1112013 07/1112014 $50,000.Bond Limit <br /> 3rd Pa <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,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 /> P.O. BOX 8181 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> orough,NC 27278 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> i <br /> ATTN• Tammy Comar AUTHORIZED REPRESENTA <br /> E-Mail: tcomar @orangecountync.gov , <br /> E-Mail: PatfApronetsysternsiric.corn <br /> _ e 488-2010 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2010105)r� ., T ACORD name and logo are registered marks of ACORD <br />