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DocuSign Envelope ID:C04FE605-67A5-452F-B8DF-C910339AD48B
<br /> COW �3
<br /> CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY)04!07/2017
<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 have ADDITIONAL INSURED provisions or he endorsed,
<br /> If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on
<br /> this certificate does not confer rights to the certificate holder in lieu of such endorsement(s),
<br /> PRODUCER CONTACT .NAME Amy H.Paschal —
<br /> Ken B.Lawson,Jr. f , 9 1 9-8 4 6-2 0 9 0 ext 105 `tai,N4_919.846_2438
<br /> Ken Lawson,Jr.Agency EMAIL aschaaenatianwlde.com
<br /> 6512-101 Six Forks Road INSURER(S)AFFORDING COVERAGE _____ „ NAICN
<br /> Raleigh,NC 27615 INSURERA. Nationwide Mutual Insurance Company 23787 ,
<br /> INSURED INSURERS: NorGUARD Insurance Company 25844
<br /> ProNet Systems,Inc. INSURER C: —_, __
<br /> 3200 Glen Royal Road INSURER D: j
<br /> Suite 107 INSURERE:
<br /> Raleigh,NC 27617 INSURERF: 3
<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. NOTVNTHSTANDING 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 /> INSR--- .ADO,,�t,1�3"12`h� ..�' POLICYNUMBER POlICYEFF POLICYERP.J...�
<br /> LW TYPE OF INSURANCE im _ (MMIDDIYYYY) IMM/DD/YYYYI LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY Y ACP GLO 2292994383 02!2212017 02!22/2018 EACH OCCURRENCE 1$ 1,000,000 I
<br /> DAMAGE TD REIVTEi)
<br /> 1 CLAIMS-MADE I X I OCCUR PREMIS0,000
<br /> ES..tt i oaurrarico}_ $ 1 0
<br /> 0
<br /> X Contractual Liability MED EXP(Any one person) `$ 5,000
<br /> X i Contractor's Enhancement PERSONAL&ADV INJURY $ 1,000,000
<br /> 1 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
<br /> 1 k___1 POLICY . j jE° 1 LOC PRODUCTS-COMP/OP AGG $ 2,000,000
<br /> IOTHER: $
<br /> AUTOMOBILE LIABILITY -
<br /> `` CO BIN•a N LE LE IT $
<br /> Eaccide�r Il
<br /> ANY AUTO BODILY INJURY(Per person) S
<br /> OWNED SCHEDULED
<br /> fI
<br /> AUTOS ONLY _ I AUTOS BODILY INJURY(Per accident) $
<br /> HIRED j 1 NON-OWNED PROPERTYbAMAGE
<br /> I
<br /> AUTOS ONLY i .j AUTOS ONLY ..(Pot et !dent}__ $
<br /> $
<br /> A Ei UMBRELLA!JAB X !OCCUR y ACP CAP 229994383 02122/2017 02122!2018 EACH OCCURRENCE $ 4,000,000
<br /> X EXCESS LIAB 1 CLAIMS-MADE AGGREGATE $ 4,000,000
<br /> I 1 050 X RETENTIONS none S
<br /> B 1WORKERS
<br /> AND EMPLOYERS'LIABILITY Yr N PRWC836165 04!03!201704/03/2018 x srAruTE LERI, L
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE 1 E L.EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMSFREXCIUDED? Y N/A —
<br /> (Mandatory In NH) j E,L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> It yyes,desesbo under
<br /> i DESCRIPTION OF OPERATIONS below ( E"L.DISEASE-POLICY LIMIT $ 1,000,0()0
<br /> Tools and Equipment 1 Installation Floater $75,000.Limit
<br /> A Commercial Inland Marine ACP CIM 2292994383 02!22/2017 02!22/2018 Contractors Equip $22,250.Limit
<br /> All Job Sites of the Insured $500./141000.Ded Respectively
<br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
<br /> Orange County Is included as additional Insured and Waiver of Subrogation applies per Blanket Contractors Enhancement
<br /> Endorsement CO 72 88 under the general liability policy(please refer to attachments). The Umbrella/Excess Liability policy is"follow
<br /> form". Blanket Waiver of Subrogation also applies to the workers compensation policy(please refer to attachments).
<br /> .
<br /> CERTIFICATE HOLDER CANCELLATION ,
<br /> Orange County
<br /> P.O.Box 8181 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Hillsborough,NC 27278 ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> E-Mall: tcomar @orangecountync.gov AUTHORIZEOREPRe$EHTAlVE
<br /> E-Mail: anitaJ©pronetsystemsnc.com "
<br /> I E-Mail: patftpronetsystemsnc.com �' ,','' •` / I`
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2018/03) I I I L� r� /,.The ACORD name and logo are registered marks of ACORD
<br /> ,I
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