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DocuSign Envelope ID: BBE2812E-C8CC-4A62-A991-7B4A2DC9F2F3 <br /> IV DATE(MM/DD/YYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE 02/19/2016 <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 NAME:CONTACT Amy H.Paschal <br /> Ken B.Lawson,Jr. sac°.,E Ext): 919-846-_2090 ext 105 FAX 919-846-2090 No): 919-846-2438 <br /> dba Lawson Insurance Group,Inc. -MAIL <br /> p, nc. ADDRESS: p ascaa @ h nationwide.com <br /> 6512-101 Six Forks Road INSURERIS)AFFORDING COVERAGE _ NAIC# <br /> Raleigh,NC 27615 INSURERA: Nationwide Mutual Insurance Company 23787 <br /> INSURED INSURER B: AmGUARD Insurance Company 21873 <br /> ProNet Systems,Inc. INSURERC: Nationwide Mutual Fire Ins Company 23779 <br /> 3200 Glen Royal Road INSURERD: <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 /> ILTR TYPE OF INSURANCE INSD WVD I POLICY NUMBER M1OS+OO YYY MM+ODfYYYY LIMITS <br /> LTR <br /> A X COMMERCIAL GENERAL LIABILITY Y Y ACP2272994383 02/22/201602/22/20171 EACH OCCURRENCE I $ 1,000,000 <br /> DAMAGE TO RENTED 1 $ 100 000 <br /> CLAIMS-MADE <br /> X1 OCCUR PREMISES rre <br /> _jEa o�cunr� <br /> X Contractual Liability MED EXP(Any one person) $ 5,000 <br /> X , Contractor's Enhancement PERSONAL BADVINJURY $ 1,000,000 <br /> FEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE _$ 2,000,0_00 <br /> � POLICY X I JECT F] LOC PRODUCTS-COMP_IOPAGG $ 2,000,000 <br /> OTHER $ <br /> C. AUTOMOBILE LIABILITY Y Y ACP3006921314 12/31/201512/31/2016 COMBINED INLE LIMIT $ 1,000,000 <br /> X ANY AUTO BODILY INJURY(Per person) $ <br /> X ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> X HIREDAUTOS X <br /> NON-OWNED 1 PROPERTY Prramdentl�AMAGE $ <br /> _ AUTOS <br /> I� $ <br /> A X UMBRELLA LIAB I X I OCCUR Y Y ACP227994383 02/22/2016 02/22/20171 EACH OCCURRENCE $ 4,000,000 <br /> X EXCESS LIAB 1 I CLAIMS-MADE AGGREGATE $ 4,000,000 <br /> . DED X I RETENTION$ none I 1 I$ <br /> B WORKERS COMPENSATION Y PRWC663376 '04I03I201504/03/2016 X <br /> 'AND EMPLOYERS'LIABILITY STATUTE OF <br /> ANY P R OP R I E TORfPA RTNER+EXEC U TI VE IN EL EACH ACCIDENT $ 1,000,000 <br /> OFFICERiMEMSER EXCLUDED? Y NIA <br /> (Mandatory in NH) 1 EL DISEASE-EA EMPLOYEE $ 1,000,000 <br /> If yes describe under <br /> DESCRIPTION OF OPERATIONS t*ow 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(please refer to attachments). The Umbrella/Excess Liability policy is"follow <br /> form". Blanket Waiver of Subrogation also applies to the workers compensation policy(please refer to attachments). <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,NC 27278 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> E-Mail: tcomar @orangecountync.gov AUTHO7 7D REP eNTn�vE <br /> E-Mail: anitaj @pronetsystemsnc.com //� <br /> 1 E-Mail: paff@pronetsystemsnc.com --�- <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />