Orange County NC Website
Browse       Search
DocuSign Envelope ID:8C76AC55-47F3-402E-BCB6-9F4F62ABD9D0 <br /> 7,TO/02/2018 <br /> E(MM/DD/YYYY) <br /> ACORO° CERTIFICATE OF LIABILITY INSURANCE <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:CONTACT Amy H. Paschal <br /> Ken B. Lawson,Jr. PWHC"o Ext: 919-846-2090 ext 105 ac No): 919-846-2438 <br /> Ken Lawson, Jr.A E-MAIL <br /> Agency Y ADDRESS: Y•p @ am aschal lawsonins.com <br /> 6512-101 Six Forks Road INSURER(S)AFFORDING COVERAGE NAIC# <br /> Raleigh, NC 27615 INSURER A: Nationwide Mutual Insurance Company 23787 <br /> INSURED INSURER B: NorGUARD Insurance Company 25844 <br /> ProNet Systems, Inc. INSURER C <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 IN SD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY <br /> A X COMMERCIAL GENERAL LIABILITY y ACP GLO 2292994383 02/22/201802/22/2019 EACH OCCURRENCE $ 1,000,000 <br /> CLAIMS-MADE � OCCUR PREMISES <br /> Ea occur DAMAGE TO RENTED <br /> $ 100,000 <br /> X Contractual Liability MED EXP(Any one person) $ 5,000 <br /> Contractor's Enhancement PERSONAL&ADV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> � PRO- <br /> POLICY LOC PRODUCTS-COMP/OPAGG $ 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 /> E $ <br /> A X UMBRELLA LIAB X OCCUR Y ACP CAF 229994383 02/22/2018 02/22/2019 EACH OCCURRENCE $ 4,000,000 <br /> X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 4,000,000 <br /> DED RETENTION$ 0 $ <br /> B WORKERS COMPENSATION Y PRWC836165 04/03/201804/03/20191 STATUTE ER <br /> AND EMPLOYERS'LIABILITY <br /> ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 <br /> OFFICER/M EMBER EXCLUDED? I YJ NIA <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 /> A Commercial Inland Marine ACP CIM 2292994383 02122/201802/22/2019 Contractors Equip $22,250. Limit <br /> All Job Sites of the Insured <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(CG 20 33)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, NC 27278 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> E-M a I l: AUTHORIZED REPRESENTAT <br /> E-Mail: anitaj@pronetsystemsnc.com <br /> E-Mail: atf@ronetsystemsnc.com <br /> 1 88-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />