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DocuSign Envelope ID: D7E43DD4-EA19-459A-861 F-E601909C0459
<br /> AC RV CERTIFICATE OF LIABILITY INSURANCE ATE
<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(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 endorsoment s.
<br /> PRODUCER NAME:CT
<br /> Amy H.(Paschal
<br /> Ken B'Lawson,Jr. Aar Np,.FI,IS 919...:846..2090 ext 1.05 i dare,any 919-84!6-2438
<br /> dba Lawson Insurance Group, c. E-MAIL asclnaa nati'on�nrlde,crrm
<br /> F�, ADDRESS: paschaa@nationwide.com
<br /> 6512-101 Six Forks Road! ! 1 _ .. _....�.____... —.
<br /> . gt?suR�a s�,��oROlrara cOVERAOE
<br /> Raleigh,INC 27615 INSURER Nationwide Mutual Insurance Company
<br /> __,__ ,_ ___ ...._ _. ........... ............
<br /> INSURED INSURER 8. AmGUARD Insurance Company
<br /> ProNet Systems,Inc. INSURER Nationwide Fire Insurance Company
<br /> _m _ - ---._..._ .....
<br /> 3200 Glen Royal Road INSURER Progressive Southeastern Insurance Co.
<br /> Suite 107 _ _. _ ...........
<br /> INSURER E
<br /> Raleigh,NC 27617 1 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 /> iLTR TYPE.OF INSURANCE FINED SUER POLICY EFF POLICY EXP LIMITS
<br /> LTR POLICY NUMBER MMPDDrNNYY MMrLPD NYN
<br /> X COMMERCIAL GENERALLIABILITY ACP 2262994383 02122120140212212015 EACH OCCURRENCE $ 1,000',000
<br /> A DAMA E TO RENTED
<br /> .....�CLA.IMS-MADE �OCCUR _PREMISES'&_vccurran S 100,0i00
<br /> X Contractual Liability MED E)fP IAny one person,i $' 6,000
<br /> ........ ........._ ........... ........
<br /> X Contractor's Enhancement PERSONAL d ADV INJURY $ 1:000;000'
<br /> _._ _ __............
<br /> GEN'L AGGREGATE LIMIT APPLIES PER GEINERI AGGREGATE $ 2„000,000
<br /> POLOY X JE T LOC PRODUCTS-CC}MP/OP AGG $ 2,000,000
<br /> OTHER:
<br /> C AUTOMOBILE LIABILITY ACP 3006921314 12131/201412/3112015 � adBeN crSINGLE uMiT 1 000,000
<br /> D ANY AUTO 07864851-3 04/13/201412/31/201+1 BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULED _...O (Per_ AUTO'S ................ AUTOS BODILY INJURY gPer accadtarot) $
<br /> ..........w..... _ .-,-,.._. _...--
<br /> X Nt7Ni�47'N+1VEC: Fa'ROPERTY DAMiAGE �
<br /> X HIREOAdTOS ..,,.._._ AUd'OS Peracaaien
<br /> X UMBRELLA LIAR X OCCUR ACP2262994383 02/22/201140212.212015 EACH OCCURRENCE $ 4,000,000
<br /> A X EXCESS LIAR C,,,S-,AE AGGREGATE 4,000,000
<br /> DIED X I RETENTION$ None $
<br /> WORKERS COMPENSATION i PRWC662943 0410312014 0410...3.12015 ,X PER 011
<br /> AND EMPLOYERS'LIABILITY --- S�'A'14JT[-._ _ f_Ft__- ..._..... ._ ___...._ _.-.-....
<br /> B ANY PROPRIETOR)PARTNEWEXECUTIVE N�I NIA
<br /> E L.EACH ACCIDENT $ 500„000
<br /> OFFICEWMEMSER EXCLUDED? Y
<br /> (Mandatory in NHI E L.DISEASE-EA EMPLOYE $ 500„000
<br /> K yyes describe gender ..,.,.._.. ....,_... ._. ......... .........._ .. .._. ....... .. ....
<br /> DESCRIPTION OF OPERATONS Wow E...L.DISEASE.POLUCY LIMIT $ 500,000
<br /> A Business Services Bond 7900388862 07111/2014' 7111/2015 $50,000. Bond Limit
<br /> (3rd Party
<br /> DESCRIPTION OAF OPERATION'S I LOCATIONS I VEHICLES IACORD 101,Additional Remarks Schedule,may be attached if more space is mqui
<br /> Change County is included as additional insured where applicable per Blanket Contractors Enhancement Endorsement CG 72 88.
<br /> Waiver of Subrogation applies per endorsement.
<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 /> Hillsborough,INC 27278 ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> i
<br /> µ
<br /> AUTHORIZED REPRE SENTA
<br /> 1 88-2014)(CORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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