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DocuSign Envelope ID:Al C83FEE-31 EA-4804-A792-98DFA71 B8DC2
<br /> CERTIFICATE OF LIABILITY INSURANCE DATE IMMIDOPYYYYI
<br /> 1212212014
<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 pollcy(les) 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 CONTACT Arny H.Paschal
<br /> .... _..
<br /> Ken B Lawson,Jr. PH X0.1 ant 919-846-2090 ext 1115 FAX c,,rrc1. 9'19-846 2438
<br /> .......
<br /> dba Lawson Insurance Group,Inc, E-MAIL ascltaa nationWidevcom
<br /> p ADDRESS, P V
<br /> 6512-1011 Six Forks Road
<br /> .......__ w�t/'SUR�txt�sl.AFTORDIN covERApE NAIL a
<br /> Raleigh,INC 27615 INSURER A: Nationwide Mutual Insurance Company
<br /> INSURED _......_......._,.... ......
<br /> INSURER B: AmGARD Insurance Company
<br /> ProNet Systems,Inc,. INSURER C, Nationwide Fire Insurance!Colmpany
<br /> 3200 Glen Royal Road INSURER D Progressive Southeastern Insurance Co,.
<br /> . ..-....._
<br /> Suite 107
<br /> INSURER E:
<br /> Raleigh,NC 27617 INSURER
<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 /> INDICA TED. 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 CLAIIMS.
<br /> - ._ ... .....— _ -..-.. .. . ........... ... -------
<br /> IL ` .. TYPE OF INSURANCE .....rvaDDL�UBb�'I PCILICY NUMBER.. �'MM/DO(YYEV'YY MMDI DIYYY+ LIMITS ..........
<br /> YYY
<br /> ,X" COMMERCIAL GENERAL LIABILITY ACP 2262994383 0212212014 2122/2015 FACHOCCURRENCE $ 1,000,000
<br /> ( .47A6r!'At"I-11.Y iNdfCEb ._........ .. .. ...
<br /> A CLAIMS-M7ADF (OCCUR � PRE M6SE2LB.�.T�u¢CPIC-1. .0001000
<br /> }( Contractual Llabnll MtED PAP(Any a rtr Ir r�t,ny 5,000
<br /> Contractor's Enhancement..._ .. _...
<br /> t I PERKC7NAfl a aDu INJURY � ti,IJ,010M,I�Qp
<br /> .GEW L AGGREGATE LIM1MITAPPLIES PER $ 2,000„000..
<br /> POLICY 7t i'IIh ' . ....... LOG t s 2,000,000
<br /> a I M cn; $
<br /> C AUTOMOBILE LIABILITY ACP 3010,6921314 12/311201'4112/31/2015 CO SINEe1DtSINGLF UMIT $ 1,000,000
<br /> D ANY AUTO 017864851-3 04/13/20141213112014 BODILY INJURY iPer treraan) $
<br /> .,ALL w".} IED SCHEDULE .._.. .....
<br /> A4,r""i'WN .. AUJriDs, BODILY INJURY(Per acrrd'ecokp�$
<br /> ONOVWNFD PROPERTY DAlulAaE:
<br /> X 'HIRED AUTOS P.,AUTOS j iP�varc�c1urrl; ,,, �$..._..— ................__ ...
<br /> �$
<br /> J X J UMBRELLA LIAR �'zcCUR ACP 2'262'994383 02/2212014 212212015�,,I�Aqt_qqquRRENCE $ 4,000,000
<br /> A III RETEIVTICN$ aCOCar. .. s -0,000,000
<br /> ALMA -:IAA
<br /> None f S
<br /> jWORKERS COMPENSATION PRWC552.943 014/031201404103/2016 X PER 04H-
<br /> ANO EMPLOYERS LIABILITY R....... ..
<br /> ^,TATLITr._
<br /> 13, ANYPRC.PRIEIDHtPAR"INEHrrx��U71VL YIN N E.L EA rIAaCIDENM s 500,000
<br /> aaFrix�,FF�,rnEM,��aLReXcLLVOeD? '�'
<br /> iMlandatoryinNH) °°°°°m._.i F1..DISEASF EA EMPLOYE S 500,000
<br /> if yes descriibe w1de� .... ....... .... ..... ---. ...------
<br /> DESCRWTION ryF OPERATIONS below E .DISEASE t PC7I IGY LIWT $ 500,000
<br /> A 'Business Services Bond 7900388862 07/11/2014137/111/2015!$50,000.Bond Limit
<br /> (3rd Party)
<br /> Dr SCRIPIION OF OPERATIONS I LOCATIONS;VEHICLES iACORD$01,Additi©otai Remarks Schedule,may be attached it more siaaee Is required)
<br /> Orange County is included as additional insured where applicable per Blanket Contractors Enhancement Endorsement CIS 72 88.
<br /> Waiver of Subrogation applies per endorsement.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> Orange County
<br /> P.03,Box 8181 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Hillsborough,NC 27278 ACCORDANCE WITH THE POLICY PROVISIONS,
<br /> AUTHORIZED REPRESE.NTAT
<br /> 1 88420114 CORD CORPORATION, AIIII rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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