2016-510-E AMS - ProNet Systems, Inc. for security for Orange Works (DSS expansion)

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DocuSign Envelope ID:ADF088D6-1067-4D7C-B1 FF-051AF22D0A32 ACCORD® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 03/29/2016 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 have ADDITIONAL INSURED provisions or 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 CONTACT Amy H.Paschal Ken B.Lawson,Jr. (A/CC.Nr o.Ext): 919-846-2090 ext 105 FAAic,No) 919-846-2438 Ken Lawson,Jr.Agency Ai Ress: paschaa @nationwide.com 6512-101 Six Forks Road INSURER(S)AFFORDING COVERAGE NAIC# Raleigh, NC 27615 INSURERA: Nationwide Mutual Insurance Company 23787 INSURED INSURER(: AmGUARD Insurance Company 13781 ProNet Systems,Inc. INSURERC: Nationwide Mutual Fire Ins Company 23779 3200 Glen Royal Road INSURER D Suite 107 INSURERE: Raleigh, NC 27617 INSURERF: 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. R TYPE OF INSURANCE ANSD WVD POLICY NUMBER POLICY EFF POLICY EXP T LIMITS (MM/DD/YYYY) (MMIDD/YYYY) A X COMMERCIAL GENERAL LIABILITY y ACP GLO 2282994383 02/22/2016 02/22/2017 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PR S RENTED PREMISES(( 100,000 occurrence) $ ,000 X Contractual Liability MED EXP(Any one person) $ 5,000 X Contractor's Enhancement PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JECT LOC PRODUCTS-COMP/OP AGO $ 2,000,000 OTHER: $ C AUTOMOBILE LIABILITY y ACP BAF 3016921314 12/31/201512/31/2016 0aBccideDn INGLELIMIT $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ X OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) A X UMBRELLA LIAB X OCCUR Y ACP CAF 228994383 02/22/201602/22/2017 EACH OCCURRENCE $ 4,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 4,000,000 DED X RETENTION$ none $ B WORKERS COMPENSATION PRWC700473 04/03/2016 04/03/2017 X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? Y N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Tools and Equipment Installation Floater/Equipment A Commercial Inland Marine ACP CIM 2282994383 02/22/201602/22/2017 $75,000.Limit/$500 Deductible All Job Sites of the Insured $22,250.Limit/$100p. Deductible DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space 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 AUTHORIZED REPR ENTATJVE E-Mail: anitaj @pronetsystemsnc.com ' } s if / 'J 1E-Mail: patf @pronetsystemsnc.com `'"+� `f ,1 f ; ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD