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DocuSign Envelope ID: BEC19F48-B45F-4E24-9BO6-51OE862BB015
<br /> ,aY� DATE(MM/DDIYYYY)
<br /> A' CERTIFICATE OF LIABILITY INSURANCE 04/30/2015
<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 NAE CONTACT' Amy H.Paschal
<br /> Ken B.Lawson,Jr. JAIC"Nr E,xt) 919-846 2090 (A/CpNo): 919-846-2438
<br /> dba Lawson Insurance P
<br /> Group,Inc. E-MAIL
<br /> ADDRESS. aschaa nationwide.com
<br /> 6612-101 SIX Forks Road INSURER(S),AFFORDING COVERAGE NAIC#
<br /> -...
<br /> Raleigh,NC 27615
<br /> INSURER A: Nationwide Mutual Insurance Company 1 23787
<br /> INSURED INSURER B: 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 INSURER E:
<br /> Raleigh,INC 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 /> INSTRR TYPE OF INSURANCE -`ADDL�SUBR POLICY NUMBER MOLICYIYYYY M DDY XP ......... ...... ......... ......... ...... .........
<br /> YYY LIMITS
<br /> A IX, COMMERCIAL GENERAL LIABILITY Y Y ACP2272994383 02122/2015 2/22/2016 EACH OCCURRENCE $ 1,000,000
<br /> CLAIMS-MADE ,X OCCUR DAMAGE 1:0 RENTED 100 00
<br /> .... ........................ ...PREMISES(Ea c�rcelrrenr_,ey $ 0......
<br /> X j Contractual Liability MED EXP(Any one person) $ 5,000
<br /> ........ ........
<br /> X 'Contractor's Enhancement PERSONAL $ 1,000,000
<br /> ......... ......... ........
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> PRO- ( I
<br /> POLICY I X I JECT u LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> OrHE;R $
<br /> C AUTOMOBILE LIABILITY Y Y ACP3006921314 12/31I201512I3112016MNaED a SINGLE LIrnII $ 1,000,000
<br /> X ANY AUTO _ BODILY INJURY(Per person) S
<br /> X ....ALL OWNED t SCHEDULED
<br /> AUTOS AUTOS BODILY INJURY(Per accident) $
<br /> '..
<br /> X :. HIREDAUTOS ;X
<br /> NON-OWNED N gPeW anc��AMA.GE $
<br /> A X UMBRELLA LIAB X OCCUR Y Y ACP227994383 02122/201500212212016 EACH OCCURRENCE $ 4,000,000
<br /> X EXCESS L1Ae CLAIMS MADE AGGREGATE $ 4,000,000
<br /> DED X �RETENTION$ none $
<br /> B WORKERS COMPENSATION Y PRWC663376 04/03/2015 04/03/20161 X I$7ATUTE OR"
<br /> AND EMPLOYERS'LIABILITY YIN .
<br /> A Y PR0PRI'ETORIPARTNFR/EKE:C'UTIVE NIA EL EACH ACCIDENT $ 1,000,000
<br /> 01'rICERIMEMRER EXCLUDED? � .....
<br /> (MandatM In NH) EL DISEASE•EA EMPLO r'EE, $ 1,000,000
<br /> If yes describe under _. , .......
<br /> DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 1,000,000
<br /> i
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is 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,INC 27278
<br /> AUTHORIZED REPRE:'SE.NTAT.
<br /> E-Mail: tcomar @orangecountync.gov
<br /> E-Mail: paMpronetsystemsnc.com
<br /> (_,4)11(88-2014 WCORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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