|
DocuSign Envelope ID:61 D935B5-E8CF-4CEE-BB06-4E876E1 11 5DO
<br /> CERTIFICATE OF LIABILITY INSURANCE DATE{MM,D°"YYY'
<br /> 04130/2015
<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 CONTACT Amy H.Paschal
<br /> Ken B.Lawson,Jr. PHONE 918.846-2090 FAX 919-846-2438
<br /> _(AIC,No,Eat).- {AIC,No4 _-8
<br /> dba Lawson insurance Group,Inc. ADDRESS: paschaa @nationwide.com
<br /> 6512401 SIX Forks Road INSURER(S)AFFORDING COVERAGE NAIC#
<br /> Raleigh,NC 27615 INSURER A. Nationwide Mutual Insurance Company 23787
<br /> INSURED INSURERS: AmGUARD Insurance Company 21873
<br /> ProNet Systems,Inc. INSURER c: Nationwide Mutual Fire Ins Company 23779
<br /> 3200 Glen Royal Road INSURER D:
<br /> Suite 107
<br /> INSURER E
<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 AWOL SUER __- _.. POLICY EFF POLICY EXP -
<br /> POLICY NUMBER MMIDDIYYYY l MMlODfVYYY ( LIMITS
<br /> A '..X COMMERCIAL GENERALLIABILnY Y Y '.:ACP2272994383 :'02122/201602122/2016!EACH OCCURRENCE $ 1,000,000
<br /> oAninCe o IIrTElti $
<br /> CLAIMS-MADE X OCCUR
<br /> 100 000,PREyI$cSIEa}^currcn.-e]. ,.
<br /> X Contractual Liability MED EXP(Any one person) S6,000
<br /> ——
<br /> X Contractor's Enhancement
<br /> PERSONAL&ADV INJURY _S 1.000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: i GENERAL AGGREGATE $ 2,000,000
<br /> POLICY X PRO-
<br /> JECT LOC
<br /> PRODUCTS-COMPIOPAGG $ 2,000,000
<br /> OTHER i , $
<br /> C AUTOMOBILE LIABIUTY Y Y ACP3006921314 ,12/31/2015;12131/2016 1 G6a�de°ISINSLELIMIT $ 1,000,000
<br /> X ANY AUTO _ _ BODILY INJURY(Per person) S
<br /> _ i
<br /> ALL OWNED SCHEDULED -
<br /> 1 X AUTOS I AUTOS �BODILY INJURY(Per accident) $
<br /> NON OWNED 1�ROPEPI r DA AC
<br /> ----" -
<br /> X.. HIRED AUTOS
<br /> X'�AUl-OS $
<br /> _ (Perac7tlenal
<br /> i
<br /> $
<br /> A X UMBRELLAL1AB X OCCUR Y Y ACP227994383 02/2212015,62122120161 EACH OCCURRENCE s 4,000 000
<br /> -- - - r
<br /> �X EXCESSLUIB !CLAIMS-MADE AGGREGATE _.�5..4,000,000 ._.
<br /> DED '•X RETENTIONS none .._. __... .. _.
<br /> B "AND EMPLOYERS'LIABILITY YIN ! Y ,PRWC663376 `04103/2015'04/03/2016 X ; nrurE ER"
<br /> 1WORPROP COMPENSATION E , ,E ECUTIVF �,N/A'i EL EACH ACCIDENT $ 1,000,060
<br /> {(Mandatory In NH) ! EL DISEASE•EA EMPLOYEE$ 1,000,000
<br /> Il'yes.describe under
<br /> !DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ 1,000,600
<br /> i
<br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES(ACORD 101,Additional Renwrks Schedule,may be attached If more space le required)
<br /> Orange County is included as additional insured and Waiver of Subrogation applies per Blanket Contractors Enhancement
<br /> Endorsement CG 72 88 under the general liability policy. The Umbrella/Excess Liability policy is"follow form"(please refer to
<br /> attachment). Blanket Waiver of Subrogation also applies to the workers compensation policy(please refer to attachment).
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> Orange County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> P.O.BOX 8181 ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Hillsborough,NC 27278
<br /> AUTHORIZED REPRESENTA
<br /> E-Mail: tcomar@orangecountync.gov
<br /> I E-Mail: patf@pronetsystemsne.com
<br /> .61 88-2014 CORD CORPORATION. All rights reserved.
<br /> ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD
<br />
|