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DocuSign Envelope ID:AO5BAC11-3B82-4B08-8F14-C38030E0460A
<br /> "*^
<br /> A Rb CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
<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 /> 1 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). 1
<br /> ,PRODUCER NAMEACi" Amy H.Paschal.
<br /> Ken B.Lawson,Jr. IAHrG;No,Ex t); 919-846-2090 ext 105 AX Nt); 919-846-2438
<br /> dba Lawson Insurance Group,Inc. AARE SS paschaa@nationwide.com
<br /> 6512-101 Six Forks Road INSURER(S)AFFORDING COVERAGE NAIC#
<br /> Raleigh,NC 27615 INSURER A: Nationwide Mutual Insurance Company 23787
<br /> INSURED INSURERB: AmGUARD Insurance Company 21873
<br /> ProNet Systems,Inc. INSURER C: Nationwide Mutual Fire Ins Company 23779
<br /> 3200 Glen Royal Road INSURERD:
<br /> Suite 107 INSURER E.:
<br /> Raleigh,NC 27617 INSURERF:
<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 /> .,,...... TYPE OF INSURANCE ........ U.. ..- ---POLICY NUMBER C POLICY EXP .,,,,,, ,,, ................ .........
<br /> ILTR INSD SUER
<br /> WVD AMMIDDIYYYY) IMM/DD!YYYY) LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY Y Y ACP2272994383 02/22/201602/22/2017 EACH OCCURRENCE $ 1,000,000
<br /> DAMAGE TO RENTED ...... ....
<br /> CLAIMS-MADE X OCCUR - ,PREMISES(Ea(x.cuarencE $ 100,000
<br /> X Contractual Liability MED EXP(Any one person) $ 5,000
<br /> X Contractor's Enhancement PERSONAL BADV INJURY 1$ 1,000,000
<br /> GE 'L AGGREGATE LIMIT APPLIES PER I GENERAL AGGREGATE $ 2,000,000
<br /> I'I'2.0
<br /> POLICY LX JFC'1' r I LOC PRODUCTS COMP/OP AGG $ 2,000,000
<br /> OTHER $
<br /> C AUTOMOBILE LIABILITY i Y Y ACP3006921314 12/31/201512/31/2016 COMBINED a 1 LIMIT SINGLE $ 1,000,000
<br /> X =ANY AUTO BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULED ..... .I..
<br /> X AUTOS AUTOS BODILY INJURY(Per accident) $
<br /> NON-OWNED PROPERTY DAMAGE $
<br /> X )HIRED AUTOS X,.,. AUTOS ._Ter edenI.V.........
<br /> A X UMBRELLA LIAB X OCCUR Y Y ACP227994383 ;02/22/201602/22/20171 EACH OCCURRENCE 1$ 4,000 000
<br /> X EXCESS LIAB CLAIMS MADE - AGGREGATE $ 4,000 000
<br /> DED II
<br /> X I RETENTION$ none $ ry
<br /> B WORKERS COMPENSATION Y PRWC663376 04/03/201504/03/2016 X ISTAR.TUTF 1 GtH
<br /> 1 AND EMPLOYERS LIABILITY
<br /> 1 PEX IYYNII NIA EL EACH ACCIDENT $ 1,000,000
<br /> F Mandato in NH) E L DISEASE-EA EMPLOYEE $ 1,000,000
<br /> IV es describe under
<br /> IDESCRIPTIONOF OPERATIONS tinaw EL DISEASE-POLICY LIMIT $ 1,000,000
<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 AUTTIORMED REPR, ENTA 'VE
<br /> E-Mail: anitaj @pronetsystemsnc.com w /
<br /> I E-Mail: patf@pronetsystemsnc.com e r ©1988-2014 ACORD� �.w
<br /> D CORPORATION. All rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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