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DocuSign Envelope ID:25652F75-AF12-4268-84EE-407518477C5B
<br /> DATE(MM/DD/YYYY)
<br /> ACCOR ` CERTIFICATE OF LIABILITY INSURANCE
<br /> 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 CONTA Amy H.Paschal..
<br /> ...
<br /> Ken B.Lawson,Jr. (AJC,No,E,t). 919-846-2090 ext 105 FAX No); 919-846-2438
<br /> dba Lawson Insurance Group,Inc. -MAIL aschaa tiationwide.com
<br /> p� nc. p ADDRESS:: @
<br /> 6512-101 Six Forks Road _ INSURER(S),AFFORDING COVERAGE NAIC#
<br /> Raleigh,NC 27615 INSURERA Nationwide Mutual Insurance Company 23787
<br /> ........ .........
<br /> INSURED INSURER B: AmGUARD Insurance Company 21873
<br /> ...... .........
<br /> ProNet Systems,Inc. INSURER C: Nationwide Mutual Fire Ins Company 23779
<br /> 3200 Glen Royal Road INSURERD:
<br /> Suite 107 INSURER E.:
<br /> .........
<br /> ....
<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 /> LTR ......... ....... ........ .._.._..- --- . POLICY EXP ...... ,,. ................ .........
<br /> ILTR TYPE OF INSURANCE NS SUER POLICY NUMBER hPlt PpOC,1YYlYEr'YV MMiODdY'YYY LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY Y Y ACP2272994383 02/22/2016102/22/2017 EACH OCCURRENCE $ 1,0001000
<br /> .....
<br /> CLAIMS-MADE X OCCUR ,-PREMISES(E.a.DAMAGE TO RENTED occurTence $ 100,000
<br /> X Contractual Liability MED EXP(An_y one person) $ 5,000
<br /> ........ ..............
<br /> X Contractors Enhancement PERSONAL BADVINJURY I.$ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE ,$ 2,000,000
<br /> I'I'2.0
<br /> POLICY L..X JFC'1' � LOC PRODUCTS COMP/OPAGG $ 2,000,000
<br /> OTHER $
<br /> C AUTOMOBILE LIABILITY i Y Y ACP3006121314 12/31/201512/31/2016 8I EeDtSINGLE LIMIT $ 1,000,000
<br /> X =ANY AUTO BODILY INJURY(Per person) $
<br /> —..;ALL OWNED SCHEDULED
<br /> .X AUTOS AUTOS BODILY INJURY(Per accident) $
<br /> _ NON-OWNED PROPER1Y DAMAGE $
<br /> X )
<br /> HIRED AUTOS X,.,. AUTOS _L rac4den�V.........
<br /> A X UMBRELLA LIAB X OCCUR Y Y ACP227994383 02/22/2016102/22/2017€EACH OCCURRENCE $ 4,000 000
<br /> X EXCESS LIAB CLAIMS MADE AGGREGATE $ 4,000 000
<br /> ,. . ._...... ......... ......... .,.,
<br /> DED 1 X�RETENTION$ none $
<br /> B WORKERS COMPENSATION Y PRWC663376 04/03/2015 4/03/2016 X 1 STA TE 1 Err+
<br /> AND EMPLOYERS LIABILITY
<br /> 1 FIFGCEOPRIETOWPA'R-NNEW L XECUTIVE YIN!N) NIA E EACH ACCIDENT $ 1,000,000
<br /> (Mandatory in NH) (� E L DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If ds describe under -
<br /> ID SCRIPTIONOFOPERATIONSb0aw EL DISEASE-POLICY LIMIT $ 1,000,000
<br /> s
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/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 AuTHOKUZ D REPR ENTA 'VE
<br /> E-Mail: anitaj @pronetsystemsnc.com w
<br /> I E-Mail: atf ronets stemsnc.com > r °"
<br /> @ 1988-2014 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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