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DocuSign Envelope ID:6DC306FA-8025-42FD-A351-5AEB1A82A376 <br /> ® DATE(MM/DDIYYYY) <br /> AC CERTIFICATE OF LIABILITY INSURANCE <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 CONTACT Amy H.Paschal <br /> Ken B.Lawson,Jr. A/C,N Ext: 919-846-2090 ext 105 ac No: 919-846-2438 <br /> Ken Lawson Jr.Agency EMAIL pas nationwide.com <br /> g Y ADDRESS: P @ <br /> 6512-101 Six Forks Road INSURERS AFFORDING COVERAGE NAIC# <br /> Raleigh,NC 27615 INSURERA Nationwide Mutual Insurance Company 23787 <br /> INSURED INSURERB: NorGUARD Insurance Company 25844 <br /> ProNet Systems,Inc. INSURER : <br /> 3200 Glen Royal Road INSURER D: <br /> Suite 107 INSURER E: <br /> Raleigh, NC 27617 INSURER F: <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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS <br /> LTR D WVD POLICY NUMBER MM/DD MM/DD/YYYY <br /> A X COMMERCIAL GENERAL LIABILITY y ACP GLO 2292994383 02/22/201702/22/2018 EACH OCCURRENCE $. 1,000,000 <br /> IN]OCCUR DAMAGE TO RENT <br /> CLAIMS-MADE ED <br /> PREMISES Ea occurrence 100,000 <br /> $ � <br /> • Contractual Liability MED EXP(Anyone person) $ 5,000 <br /> • Contractor's Enhancement PERSONAL BADVINJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> POLICY®JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> Ea accident <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> $ <br /> A X UMBRELLA LIAB IV I OCCUR Y ACP CAF 229994383 02/22/2017 02/22/2018 EACH OCCURRENCE $ 4,000,000 <br /> X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 4,000,000 <br /> DED I X I RETENTION$ none $ <br /> B WORKERS COMPENSATION PRWC836165 04/0312017 04/03/2018 X STATUTE ORH <br /> AND EMPLOYERS'LIABILITY <br /> ANYPROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 1,000,000 <br /> OFFICERlMEMBEREXCLUDED7 N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> If yes,describe under 1,000,000 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> Tools and Equipment 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. Died Respectively <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe 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 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 /> E-Mail: tcomar @orangecountync.gov AUTHO <br /> ,AD REPR ENTATJVE <br /> E-Mail: anitaj @pronetsystemsnc.com r ty >� } <br /> E-Mail: patf@pronetsystemsnc.com *t '' - - <br /> @ 1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />