DocuSign Envelope ID: 7A1847E6 -6A67- 4915 - 9830- D7E112028605
<br />A "R O CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MMIDDIY I
<br />` TYPE OF INSURANCE
<br />06/1912018
<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 />Ken B. Lawson, Jr.
<br />Lawson Insurance Group, Inc.
<br />651 Z -101 Six Forks Rd.
<br />Raleigh, INC 27615
<br />CONTACT Amy H. Paschal
<br />P "ONE 919- 846 -2090 ext 1o5 I FAX 919 -846 -2438
<br />C -.. � 1 NC No),
<br />E-MAIL ADDRESS: amy.pasehal @lawsonins.com
<br />INSVRER 5 AFFORDING COVERAGE
<br />NAIC#
<br />INSURERA: Nationwide Mutual Insurance Company
<br />23787
<br />wsuReD
<br />INSURER B; NorGUARD Insurance Company
<br />25844
<br />ProNet Systems, Inc.
<br />3200 Glen Royal Road
<br />Suite 107
<br />Raleigh, INC 27617
<br />INSURERC:
<br />A A N
<br />PRL =MISES Ea occurrence
<br />INSURERD:
<br />X
<br />INSURER E
<br />$ 5,000
<br />INSURER F:
<br />Contractor's Enhancement
<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 />SR!
<br />LTR
<br />` TYPE OF INSURANCE
<br />ADDL
<br />SUBR
<br />POLICYNUMBER
<br />{ POt1CY EFF
<br />€ MMIDDIYYYY
<br />POLICY EXP
<br />MMODIYYYY
<br />! 1 LIMITS
<br />A
<br />X
<br />I'
<br />COMMERCIAL GENERAL LIABILITY
<br />` CLAIMS -MADE I X I OCCUR
<br />Contractual Liability
<br />Y
<br />f
<br />ACP 2202994383
<br />02/22/2018
<br />0212212019
<br />i
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />A A N
<br />PRL =MISES Ea occurrence
<br />5 100,000
<br />X
<br />MED EXP (Any one person)
<br />$ 5,000
<br />X
<br />Contractor's Enhancement
<br />PERSONAL &ADVINJURY
<br />S 1,000,000
<br />�GEiN'LAGGREGATEL €MIT APPLIES PER:
<br />I� POLICY I� PRO-
<br />CT F7 LOC
<br />GENERALAGGREGATE
<br />$ 2,0OO,000
<br />c
<br />PRODUCTS - COMPIOPAGG
<br />$ 2,000,000
<br />OTHER:
<br />h
<br />g
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />H[RED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />'
<br />I
<br />i
<br />s
<br />CO 13I deDtSINGLE L[MIT
<br />E 5
<br />BODILY INJURY (per person)
<br />$
<br />I BODILY INJURY (Per accident)
<br />5
<br />I PROPERTY DAMAGE
<br />Per accident
<br />5
<br />$
<br />I
<br />I
<br />A
<br />;WORKERS
<br />B ,ANYPROPRIETORIPARTNER
<br />I
<br />I
<br />I,
<br />X
<br />UMBRELIRL]AB LX
<br />EXCESS LIAR
<br />I OCCUR
<br />CLAIMS -MADE
<br />Y
<br />NIA;
<br />ACP 2202994383
<br />PRWC838166 10410-3120181104/02/20191
<br />02/22/2018102122120191
<br />I
<br />EACH OCCURRENCE
<br />s 4,000,000
<br />AGGREGATE
<br />5 4,000,000
<br />I DED , X i RETENTIONS None
<br />COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />!EXECUTIVE YIN
<br />OFFICERIMEMBER EXCLUDED?
<br />If yes, describe under 3
<br />if in under
<br />DESCREPTION OF OPERATIONS below
<br />, )( PER OTH-
<br />STATUTE ER
<br />S
<br />', E. L. EACH ACCIDENT
<br />S 1,000 0O
<br />, 0
<br />D €SEASE - EA EMPLOYEE
<br />S 1,000,000
<br />E.L. DISEASE- POLICY LIMIT
<br />5 1,000,000
<br />A
<br />Tools and Equipment j
<br />Commercial Inland Mari ne
<br />All Job Sites of the Insured
<br />,
<br />ACP 2202994383
<br />021221201810212212019
<br />Installation Floater
<br />j
<br />Contractors Equip-$22,250.
<br />$500.1$1000. Ded respectively
<br />$75,000. Limit
<br />Limit
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I 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 (see attached).
<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, INC 27278 ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Email: abarnes @orangecountync.gov AUTHOFOZEDREPRESENTATIVE
<br />Email: anitaj @pronetsystemsnc.com
<br />I Email: patf9promtsysternsinc.corn
<br />v tv ") !'a"%Jmu %,VMr -UMA I MV- All rlgnts reserved.
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
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