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DocuSign Envelope ID:24D4B190-4278-4C04-B1E5-61741BF085C0 <br /> Q0 DATE If MIODNYYYI <br /> CERTIFICATE OF LIABILITY INSURANCE 02/2612017 <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 CONTANAME: Amy H.Paschal <br /> Ken B.Lawson,Jr. PHONEl o ext): 919-846-2090 ext 105 RwX N,i; 919-846-2438 <br /> Ken Lawson,Jr.Agency AIL <br /> ADDRESS: paschaa@nationwide.com <br /> — <br /> 6612-101 Six Forties(toad INSURERS AFFORDING COVERAGE I <br /> N <br /> Raleigh,NC 27615 INSURER A.. Nationwide Mutual Insurance Company <br /> INSURED INSURER B; AmGUARD Insurance Company -_- -21873 <br /> ProNet Systems,Inc. INSURERC: <br /> 3200 Glen Royal Road IHSUREft D — <br /> y ; <br /> Suite 107 INSURERS: <br /> Raleigh,NC 27617 INSURERF; <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 /> IHSR ADDL SUER POLICYEFF POLICY EXP <br /> LTR TYPE OFINSURANCE POL(CYNUMBER MMMDfYYYY) (MMIDDRYYYY LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY y ACP GLO 2292994383 02/2212017 0212212018 EACH OCCURRENCE $ 1,000,000 <br /> DAMAGE TO RENTED <br /> CLAIMS-MADE n OCCUR PREMISES Ea occurrence $ 100,000 <br /> X Contractual Liability MED EXP(Anyons person) S 5,000 <br /> • Contractor's Enhancement 1 PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIESPER; - GENERAL AGGREGATE $ 2,000,000 <br /> _ POLICY JECOT- LOG — <br /> PRODUCTS-COMPfOPAGG 5 2,tl0t:l,tltl0 <br /> OTHER: --- - -- S <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> OWNED SCHEDULED BODILY INJURY(Fret accklenl) $ <br /> AUTOS ONLY AUTOS <br /> ---- HIRED NON-OWNED PROPERTY DAMAGE--- $ <br /> AUTOS ONLY AUTOS ONLY Per a-Wenl _ <br /> $ <br /> A x UMBRELLA UAB }( OCCUR Y ACIa CAF 229994383 0212212017 0212212018 EACH OCCURRENCE 4,000,000 <br /> x` EXCESS 0AB CLAIMS-MADE AGGREGATE $ 4,000,000 <br /> DEO x RETENTIONS none $ <br /> B WORKERSCOMPENSATION PRWC700473 041031201604103/2017 X STATUTE ERH <br /> AND EMPLOYERS'LIABILITY <br /> ANYPROPRIETORIPARTNERIEXECUTIVE �YIN N'A E.L.EACH ACCIDENT S 1,000,000 <br /> OFFICERUMEMBEREXCLUDED? L.!_J. <br /> IMandatoryInHH) E.L-DISEASE-EA EMPLOYEE S 1,000,000 <br /> II yes,describe under 11,000,000 <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S <br /> Tools and Equipment Installation Floater $75,000.Limit <br /> A Commercial Inland Marine ACP CIM 2292994383 02/2212017 0212212018 Contractors Equip $22,250.Limit <br /> All Job Sites of the Insured $500.1141000.Ded Respectively <br /> DESCRIPTION OF OPFRATEONS I LOCAT(ONS I VEHICLES(ACORD 101,Addllional Remarks Schedule,may be attached IRmere 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 UmbrellalExcess 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.0.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: teomar@orangecountync.gov AUTOO DREPR ENTTAA ve <br /> E-Mail: anitaj@pronetsystemsne.com f +�f 1 <br /> 1 E-Mail: atf ronets stemsnc.com c'ems,. J ��aI= �--. <br /> 0 1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />