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DocuSign Envelope ID:61 D935B5-E8CF-4CEE-BB06-4E876E1 11 5DO <br /> 1111110ME BERKSHIRE HATHAW" —and <br /> 11111111�J0111111 INS41RANCE AmGUARD Insurani;e Company - A Stock Company <br /> PoIicy Number PRWC663376 <br /> U-4 G UA Rah DCOMPANIES Renewal of PRWC552943 <br /> NCC1 No. [218731 <br /> Policy Information Page <br /> ................ .............................. .... . ........ ................................. <br /> ]Named Insured and Mailing Address <br /> PRO NET SYSTEMS INC, <br /> 3200-107 Glen Royal Road <br /> Raleigh, NC 276!7 <br /> S! .�.A tS- <br /> _Ne <br /> Federal Employer's ID Insured Is Corporation <br /> Risk ID Number 6049357 <br /> L................................... ...................-—--------------- ............... -—-----------_-........................ ----------------- <br /> .......................................... ----------- ................................ <br /> [2] Policy Period <br /> From April 3,2015 to April 3, 2016, 12:01 AM,standard time at the In sured's mailing address. <br /> L ............................I............... ------------­-------­----—.1--------- ..... .................... <br /> I...........___.......... .............................. ----°.. . .......I.-............. . M.. .......................... <br /> [3] Coverage <br /> A. Workers'Compensation Insurance-Part One of this policy applies to the Workers'Compensation <br /> Law of the following states: North Carolina <br /> B. Employer's Liability Insurance-Part Two of this policy applies to work in each of the states listed <br /> in item [3]A. The Ili-nits of our liability under Part Two are: <br /> Bodily Injury by Accident-each accident $1,000,000 <br /> Bodily Injury by Disease-each employee $1,000,000 <br /> Bodily Injury by Disease-policy limit $1,000,000 <br /> C. Other States Insurance- Part Three of this policy applies to all states,except any state listed In <br /> item[3]A. and the states of North Dakota, Ohio,Washington,and Wyoming. <br /> D. This policy Includes these endorsements and schedules: <br /> . See Extension of Information Page-Schedule of Forms <br /> ................................I.,............ ---------------------- ............................. <br /> -------------- ......**------- - <br /> — ---- <br /> [4) Premium <br /> The Premium Basis and,therefore,the premium will be determined by our Manual of Rules, <br /> Classifications,Rates, and Rating Plans. All required information is subject to verification and change by <br /> audit. (Continued on another page) <br /> ..................................... .............. --------- <br /> Total EstImated Policy Premium $ 6,558 <br /> Total SurchargeslAssessments $ 0.00 <br /> Total Estimated Cost $ 6,558.00 <br /> MURNAL USE XX Page-I - Information Page <br /> -MGA :PPWC663376 WC 000001A <br /> Date :04102/2015 <br /> Issuing CAT(ce:P.D.Box A-H,16 S.River Streeftr Wilkes-Sarver PA 18703-0020 e www.guard.com <br />