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DocuSign Envelope ID: 1688DFC6- D113- 45E8- A028- E3AECF266A03
<br />�COR 7 0
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM /DDIYYYY)
<br />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 be 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
<br />NAME: Amy H. Paschal
<br />Ken B. Lawson, Jr.
<br />AICON o Ext : 919 - 846 -2090 ext 105 FAX No): 919 - 846 -2438
<br />E -MAIL aschaa nationwide.com
<br />ADDRESS: P @
<br />Ken Lawson, Jr. Agency
<br />g Y
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC#
<br />6512 -101 Six Forks Road
<br />INSURER A: Nationwide Mutual Insurance Company
<br />23787
<br />Raleigh, NC 27615
<br />INSURED
<br />INSURER B: NorGUARD Insurance Company
<br />25844
<br />INSURER C,
<br />ProNet Systems, Inc.
<br />INSURER D:
<br />3200 Glen Royal Road
<br />INSURER E :
<br />$ 1 00,000
<br />Suite 107
<br />INSURER F:
<br />$ 5,000
<br />Raleigh, NC 27617
<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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />IN SD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM /DDIYYYY
<br />POLICY EXP
<br />MM /DDIYYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Y
<br />ACP GLO 2292994383
<br />02/22/201702/22
<br />/2018
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE ® OCCUR
<br />PREMISES (E. occurrence) ence )
<br />$ 1 00,000
<br />•
<br />MED EXP (Any one person)
<br />$ 5,000
<br />Contractual Liability
<br />•
<br />Contractor's Enhancement
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY ® PECOT- F7 LOC
<br />PRODUCTS - COMP /OP AGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />(CEO, SINGLE LIMIT
<br />Ea accent
<br />$
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X.
<br />OCCUR
<br />y
<br />ACP CAF 229994383
<br />02/22/2017
<br />02/22/2018
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />X,
<br />AGGREGATE
<br />$ 4,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION $ none
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANYPROPRIETOR /PARTNER /EXECUTIVE Y / N
<br />OFFICER/MEMBEREXCLUDED? I YJ
<br />(Mandatory in NH)
<br />N/A
<br />PRWC836165
<br />04/03/201704/03
<br />/2018
<br />xC TSTEARTUTE ERH
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />Tools and Equipment
<br />Installation Floater
<br />$75,000. Limit
<br />A
<br />Commercial Inland Marine
<br />ACP CIM 2292994383
<br />02/22/201702/22
<br />/2018
<br />Contractors Equip
<br />$22,250. Limit
<br />All Job Sites of the Insured
<br />$500./141000. Ded
<br />Respectively
<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
<br />Hillsborough, NC 27278
<br />E -Mail: tcomar @orangecountync.gov
<br />E -Mail: anitaj @pronetsystemsnc.com
<br />E -Mail:
<br />msnc.com
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />RFrSENTA VE
<br />\J 1. 700 -401.7 NL,VRLJ%,Vr%r Vr%M 11V111. HI I I I $J I I Lb I tl21CIVWU.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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