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DocuSign Envelope ID:AO5BAC11-3B82-4B08-8F14-C38030E0460A <br /> * BERKSHIRE HATHAWAY . S € ea µ i r .tra i <br /> AtnGUARD Insuran a Company- A Stock Company GuARD INSURANCE Policy Number PRWC663376 <br /> COMPANIES Renewal of PRWC552943 <br /> NCCI No (21873] <br /> Policy Information Page <br /> 1]Named Insured and Mailing Address mm <br /> PRO NET SYSTEMS INC, i.zaa ort insaerc:€ce a n Fin'aacial <br /> 3200-107 Glen Royal Road <br /> Raleigh, NC 27617 '. 2.101 S:n Fork• Pc,aci. <br /> ;'....E .....':ii: I <br /> I Federal Employer's ID Insured is Corporation <br /> IRisk ID Number 6049357 <br /> [2) Policy Period <br /> From April 3, 2015 to April 3, 2016, 12:01 AM,standard time at the insured's mailing address. <br /> ...��� .,Coverage .�.. ,..�....................-. . <br /> A. Workers' Compensation Insurance -Part One of this policy applies to the Workers' Compensation <br /> Law of the following states: North Carolina <br /> B. Employer's Liability Insurance-Part Two of this policy applies to work in each of the states listed <br /> in item(31A. The limits of our liability under Part Two are: <br /> Bodily Injury by Accident-each accident $1,000,000 <br /> Bodily Injury by Disease- each employee $1,000,000 <br /> Bodily Injury by Disease- policy limit $1,000,000 <br /> C. Other States Insurance- Part Three of this policy applies to all states,except any state listed in <br /> item (3]A. and the states of North Dakota,Ohio, Washington,and Wyoming. <br /> D. This policy Includes these endorsements and schedules: <br /> See Extension of Information Page -Schedule of Forms <br /> [4] Premium <br /> The Premium Basis and,therefore,the premium will be determined by our Manual of Rules, <br /> Classifications, Rates, and Rating Plans. AU required information is subject to verification and change by <br /> audit. (Continued on another page) <br /> Total Estimated Policy Premium $ 6,558 <br /> Total Surcharges/Assessments $ 0.00 <br /> Total Estimated Cost $ 6,558.00 <br /> ',VERNAL USE XX Page- 1 - Information Page <br /> MGA : PRWC663376 p WC 000001A <br /> Date :04/02!2015 <br /> Issuing Office:Q.Q.Box A-H,16 S.River Street,Wilkes-Barre,PA 18703-0020•www.guerd.carn <br />