2016-361-E AMS - ProNet Systems, Inc. for professional consulting services

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DocuSign Envelope ID: FlE99030-036D-407F-B588-94BC3741A806 A /?D CERTIFICATE OF LIABILITY INSURANCE DATEIMM/DDIYYYYI 02/19/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER NANIACT Amy H.Paschal Ken B.Lawson,Jr. PHONE 919-846-2090 ext 105 'FAX 919-846-2438 A MI dba Lawson Insurance Group,Inc. noDTL iss; paschaa@nationwide.com 6612-101 Six Forks Road _ INSURER(S AFFORDING COVERAGE NAICt! - Raleigh,NC 27615 INSURERA: Nationwide Mutual Insurance Company 23787 INSURED INSURER B: AmGUARD Insurance Company I 21873 ProNet Systems,Inc, INSURER C: Nationwide Mutual Fire Ins Company _ 23779 3200 Glen Royal Road INSURER°: Suite 107 INSURER E: Raleigh,NC 27617 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES_LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR 1 TYPE OF INSURANCE INSD MD POLICY NUMBER i(MM/DDIYYYYI I IMMIODY ). LIMITS A I X I COMMERCIAL GENERAL LIABILITY Y Y ACP2272994383 1,02/22/201602/22/2017 EACH OCCURRENCE I S 1,000,000 DAMAGE TO RENTED I 100 000 .X.Contractual Liability MEDEXES(Eoorcurrersce} 1$ r CLAIMS-MADE X I OCCUR i PREMISES i 1 y ._......--__-- I ` t__—P_{Any one person) 1 s 6,000 X(Contractor's Enhancement PERSONAL&ADVINJURY $ 1,000,000 GE1'L AGOREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE 15 2,000,000 I POLICY X I PRO- I l I PRODUCTS COMP/OP AGG i$ 2,000,000 i JEC7 t-1 LOC I OTHER. $ C AUTOMOBILE LIABILITY V Y ACP3006921314 12/31/201512/31/2016 L "ru�°lSINGLE LIMIT $ 1,000,000 X(ANY AUTO BODILY INJURY(Per person) $ X ALL OWNED SCHEDULED € BODILY INJURY(Per accident) $ .AUTOS NON-OWNED ? i PROPERTY DAMAGE 5 X 1 HIRED AUTOS X AUTOS ! (Per accident)__--- I $ • • • A X UMBRELLA UAB 1 k OCCUR Y Y !ACP227994383 ;02/22/201602/2212017 i EACH OCCURRENCE `$ 4,000,000 X I EXCESS LIAR AGGREGATE __ $ 4,000,000 CLAIMS-MADE 1 MD I X _RETENTIONS none I i jj $ B ,WORKERS COMPENSATION Y 1 PRWC663376 '041031201504/0312016 XSTATUTE'st_ERN AND EMPLOYERS'LIABILITY ANY YIN I E.L EACH ACCIDENT $ 1,000,000 (Mandatory In EXCLUDED? 1 Y l NIA I --- ELDISEAS_E-EA EMPLOYEE 5 1,000,000 :OFFICER/MEMBER ! cr _ (!Ilyes,describe under 1 (DESCRIPTION OF OPERATIONS kaIgW ` EL DISEASE-POLICY LIMIT $ 1,000,000 I I • I I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,AddltIonal Remarks Schedule,may be attached If more apace Is required) Orange County is included as additional insured and Waiver of Subrogation applies per Blanket Contractors Enhancement Endorsement CG 72 88 under the general liability policy(please refer to attachments). The Umbrella/Excess Liability policy is"follow form". Blanket Waiver of Subrogation also applies to the workers compensation policy(please refer to attachments). CERTIFICATE HOLDER CANCELLATION Orange County P.O.Box 8181 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Hillsborough,NC 27278 ACCORDANCE WITH THE POLICY PROVISIONS. E-Mail: tcomar@orangecountync.gov AUTH0,177ED REPR ENTA]VE E-Mail: anitaJ @pronetsystemsnacomf /I y I E-Mail: patf @pronetsystemsnc.com :.-. i /) . / '='LCre°!`,:a 1:-- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD