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000uSign Envelope ID:ss4Foono'0001-^En1-9sre-4noEoreourEA <br /> CERTIFICATE OF LIABILITY INSURANCE DATE JMMIDONYYY) <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 poficy(les)must be endorsed. If SUBROGATION IS WAI:VED,subject to <br /> the terms and conditions of the pofty,certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder In lieu of such ondorsement(s). <br /> PRODUCER <br /> Amy H.Paschal <br /> Ken S.Lawson,Jr. PHONE, VAX, <br /> d1ba Lawson Insurance Group,Inc, E-MAIL <br /> ADDRESS: pasch4iaC@nationwide.com <br /> 6612-101 Six Forks Road INSURER(S)AFFORDING COVERAGE NAIC If <br /> Raleigh,NC 27616 INSURER A: Nationwide Mutual Insurance Company 23787 <br /> INSURED INSURER B AmGUARO Insurance Company 21873 <br /> ProNlet Systems,Inc, INSURER C Nationwide Mutual Fire ins Company 23779 <br /> 3200 Glen Royal Road INSURER 0: <br /> Suite 107 INSURER r: <br /> Raleigh,NC 27617 INSURER F <br /> COVERAGES CERTIFICATE NUMBEW 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 CONDlT*N OF ANY CONTRACT OR OTHER DOCUMENT WTH 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 /> POLICY EFF POLICY EXP <br /> LTIR TYPE OF INSURANCE POLICY NUMBER (NIMIDDINVI"I (MMf0WYYyY) LIMITS <br /> CLAWS MADE 'X ,OCCUR 1010,000 <br /> X Contractual Liability 6"00,0 <br /> WHER <br /> X ANY AU 10 1300R,Y INJURY(Per pnelol� 3, <br /> x ALL CANNED SCHMAED <br /> EXCESS LIAO <br /> CLAIMS MADE AGGREGAIE 4,000,000 <br /> ANY YIN EL EAC�ACCIQENT $ 1,000,000 <br /> F,I, CA5EA9E EA EMPLOYEE S 1,000,000 <br /> DE 50UPT loW OF OPERA T 0145 below L L DISLASE POLICY LIMIT s 11,000,00 <br /> —�ESCRIP VON O�;PERATIONS I LOCATIONS I VEHICLFS(ACOAD 101,AddItTartsO Remarks SchedLda,May be anathikd Of mom specs Is romt4rod) <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 EXPIRA71ON DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> P 0.Box 8181 ACCORDANCE W"THE POLICY PROVISIONS, <br /> Hillsborough,INC 27'278 <br /> AUTHORIZED REPRESENTAT <br /> 1�68-2014'ACORD COIRPORATION All rights reserved. <br /> ACORD 25(2014101) The ACORD n,ame and logo are registered marks of ACORD <br />