Orange County NC Website
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 <br />