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DocuSign Envelope ID:622E9DC1-8F03-4B1C-AA8A-1 lC1D46D7FEA <br /> INSURANCE Arxl U6►RD Incur the tdO t1 ., A Stock Company <br /> 43 ia16a R Y Policy Number 'it 76 Renewal of PRWC552943 <br /> NC CI No. [218731 <br /> Policy Information Page <br /> ......... .. ,. . <br /> ]Named insured and Mailing Address <br /> PRO NET SYSTEMS INC. <br /> 3200"107 Glen Royal Roam <br /> Raleigh, 'NC 27617 ; <br /> i Federal 'Emplay r's ID Insured its Corporation <br /> Risk ID Number 6049357 <br /> [2� Policy Period <br /> , <br /> —..---- µ._.- ....... .,_...,. ...... _.........,.. ._ ...................................... <br /> , ,. <br /> From April 3, 2015 to April 3, 2016, 12,01 AM, standard lime at that insureds marling address. r <br /> Coverage <br /> f , <br /> A. Worker Compensation Insurance - part one of this policy applies to the W+;q*er:s"Compensation <br /> l..aw of the follov,ring states: North Catofina <br /> B, Employer's Liability Insurance-Part Two of this policy applies to avork in each of the states lasted � <br /> in item i 31A, The tirnst^s of our l3abRRity under Earl:Tvvo are: I <br /> Ei,4Ry injury by Accident each accident $1,000,000 <br /> Bodily Injury by Disease - each employee $1,000,000 <br /> Bodiiy Injury by Ol seas± - policy limit �i,00i7rC70C1 <br /> } C, Other States Insurance- Dart'fhare:e of tWs policy applies to all states,except any state fisted in <br /> it=3rn (3}A, and the states of North Dakota, Oflio, Washington,ton, and Wyutnlrrg. <br /> D, This policy includes these eodorsernenLs and schedules: <br /> N Sep Extension of Inforrrratlon Page Schedule of Forms <br /> » _ <br /> reaiat <br /> T he Premium Basis and,therefore, the trerlur v4 he de termined .. <br /> k <br /> by ourr Manual of Rules, <br /> Classifications, Rates, and Rating Plans All required information is suabjert to verification and Change by <br /> audit. (CuonVnued; on another page) <br /> Total Estinnated Policy Premium 6,558 <br /> Total Surcharges/Assessments 0.00 <br /> Total Estimated Cot d� Si Mi96N <br /> Page • t _ Information Page <br /> races r RWC663376 '' WC 000001A <br /> Date .04,021201 <br /> lisswing C tw, P.O.Sox A-14,16 S.River Street,Wilkes-Sarre,PA 18 703--0020 o www.guard.com <br />