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DocuSign Envelope ID: BEC19F48-B45F-4E24-9B06-510E862BB015 <br /> BERKSHIRE HATHAWAY <br /> INSURANCE AmGUARD Insura Company R. A Stack Company <br /> " GUARD COMPANIES Pii y Number P C 3376 <br /> Renewal of PRWC a X2943 <br /> NCCI No. [21873] <br /> Policy Information Page <br /> -- _ h <br /> x <br /> ]Named Insured and Mailing Address <br /> PRO NET SYSTEMS INC, wwwwM„; <br /> PRO <br /> 3200.107 Olen Royal Road # <br /> Raleigh, felt; 27617 w <br /> s Federal Employer's ID Insured is Corporation <br /> Risk ID Number 6043357 <br /> ...,, ... ........... mm...,,,,... ., ........... <br /> [ , Policy Period <br /> p f _ d's mailing address <br /> From April 3, 241a to April 3 201�i 1�.:(I1 APB standard time at tl'sP insure <br /> A. Workers' C'ornpensation Insurance - Part One of this policy applies to the Workers' Compensation: <br /> Law of the folloveing states: Forth 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 limits of our liability sander Part Two are: { <br /> Bodily Injury by Accident_ each accident $1,000,000 <br /> Bossily Injury by Disease - each employee 11,000,000 <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 13]A. and the states of Borth Dakota, Ohio, Washington, and Wyoming. <br /> D. This policy includes these endorsements and schedules: <br /> See Extension of Information Page ° Schedule of Forms 8 <br /> [4) Premium <br /> The Premium Basis and, therefore,the premium will be determined by our Manual of Rules, <br /> Classifications, Rates, and bating Plans. All required information is subject to verification and change by <br /> audit. (Continued on another page) <br /> Total Estimated Policy Premium $ 6,558 <br /> Total Surcharges/Assessments; $ 0.00 <br /> Total Estimated Cost $ 6x.5 58.60 <br /> rvmrvm+.+,ow�++ ..wv� .Mwarnwmmww,,•.•.ww.vmwr�.ww�r+�msammwire nwwa«rnmmrvmrvx nmw.wrvr...wwawHww4wt4h.iMM <br /> JNJLRtJAL USE Y. s=age - I - Information s=age <br /> 'AGA PRWC663376 111P WC:00i1001A <br /> Date : 04/02/2015 <br /> Issuing Office-P.O.Box A-H, 16 S.€fiver Street,Wilkes-Barre,PA 18703-0020 o vsrvs¢vcr.quard.com <br />