Orange County NC Website
Browse       Search
DocuSign Envelope ID: B7458E6D-194A-4685-AAFD-91FA58B7ECA1 <br /> DATE ACOR" CERTIFICATE OF LIABILITY INSURANCE E(MMIDDIYYYY) <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 NAME: Amy H. Paschal <br /> Ken B. Lawson,Jr. A/CO"N Ext: 919-846-2090 ext 105 FAX No): 919-846-2438 <br /> Ken Lawson Jr.Agency ADDRESS: paschaa@nationwide.com <br /> E-MAIL aschaa nationwide.com <br /> g Y <br /> 6512-101 Six Forks Road INSURER(S)AFFORDING COVERAGE NAIC# <br /> Raleigh, INC 27615 INSURERA: Nationwide Mutual Insurance Company 23787 <br /> INSURED INSURERB: NorGUARD Insurance Company 25844 <br /> ProNet Systems, Inc. INSURER C: <br /> 3200 Glen Royal Road INSURER D: <br /> Suite 107 INSURER E: <br /> Raleigh, INC 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 INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY <br /> • X COMMERCIAL GENERAL LIABILITY Y ACP GLO 2292994383 02/22/201702/22/2018 EACH OCCURRENCE $ 1,000,000 <br /> CLAIMS-MADE � OCCUR PREM SES(a occurrence)l $ 100,000 <br /> X Contractual Liability MED EXP(Any one person) $ 5,000 <br /> X Contractor's Enhancement PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> POLICY� PE� 1:1 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 /> • X UMBRELLA LIAB X OCCUR Y ACP CAF 229994383 02/2212017 02/22/2018 EACH OCCURRENCE $ 4,000,000 <br /> X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 4,000,000 <br /> DED RETENTION$ none $ <br /> B WORKERS COMPENSATION PRWC836165 04/03/2017 04/03/2018 J{ STATUTE EERH <br /> AND EMPLOYERS'LIABILITY <br /> ANYPROPRIETOR/PARTNER/EXECUTIVE YIN <br /> E.L.EACH ACCIDENT $ 1,000,000 <br /> OFFICER/MEMBER EXCLUDED? I YJ N/A <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 <br /> Tools and Equipment Installation Floater $75,000. Limit <br /> • 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. Ded 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 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 AUTHORt DREPR ENTA VE <br /> E-Mail: anitaj @pronetsystemsnc.com 7 <br /> E-M il: f r n msn m F' P . <br /> a at • ets ste c c• <br /> ©1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />