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DocuSign Envelope ID: 5154D3BE-6CAD-4624-9E7E-46781 E534267 <br /> RBERKSHIRE HATHAWAY . a ilitV policv <br /> GUARD INSURANCE ArIGUARD Insura rCompany w A Stack Company� <br /> N C I Kars. f,21873] <br /> Policy Information page <br /> )Named Insured and Mailing Address <br /> PRO NET SYSTEMS It1C® <br /> 3200-107 Galen Royal Roam <br /> Ra1telgh, t4C 27617 y <br /> M <br /> Federal Errs alayer's ID Insured is Corporation a <br /> Risk 10 Number 6049357 C <br /> , <br /> ... ........ ........ . .M. . _............ ............... <br /> .. <br /> [ ) Policy Period � 4 <br /> From April 3, 2015 to April 3 2,016, i !:01 AM standard time at tine Insva�ed's marlin, address,. <br /> .... <br /> �..,.. .,Ceaw eraa e <br /> e , <br /> A. 'w�+lor3cr'rc"C°na�a�aperasatlara Insurance . Part,grAta rif'this i7c+Nicy applies to thc. Workers' Compensation <br /> i_asv of the follov+ing states: North Carolina 4 <br /> B. Employer's Liability Insurance- Part Two of this policy applies to work in each of the states HSt:ed I <br /> in item 131A, The limits of our liability under Part Two care: 1 <br /> Bodily Injury by Accident- each accident $1,000,000 <br /> Bodliy Injury by Disease - each enmloYeC $1,000,000 <br /> Bodily Injury by Disease ,. policy lirxalt $110001000 <br /> Y <br /> a <br /> C. Other States In(wrance- Part Three of this policy applies to all states,except:any state listed in <br /> 6 item [3]A.. and the states of North Dakota, Ohio, Washington, and Wyoming. <br /> av This policy includes these endorsements and schedules: <br /> See Extension of Information Paige Schedule of Forms <br /> .... ...... . ...... .. _,,.�.,..., _..,. m� __... _.. ..,.,.. . .. :_ _. ......... <br /> 1 ) Premium <br /> The Premium Basis and,therefore,the premium will be determined by our Manual of Rules, <br /> Classifications,Rates, and Parting, Plans. All required information is subject to verification and change by <br /> audit. (ConUnued on another page) <br /> Total Estimated Policy Premium $ 41,558 <br /> Total Surcharges/Assessments $ 0.00 <br /> Total Estimated Cost 6,55&00 <br /> 1 Ii#tip ti4>v! Page - 1 Inrormatron Page <br /> tAGA, PRWC663-76 VVC 0d70001 A <br /> Date 04,,'02 22015 <br /> Issuing Office:P.D.Box,rA-11,16 S.River Stir".t,Wilkes-Barre,PA Ie 7'11'3-no2o o www.9oard.com <br />