Orange County NC Website
Browse       Search
DocuSign Envelope ID: F04C1 D12-F351-4620-BCOD-3A95DF49248A <br /> DATE(MM/DD/YYYY) <br /> AC40RL> CERTIFICATE OF LIABILITY INSURANCE <br /> 7OT5/23/2019 <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 endorsements. <br /> PRODUCER CONTACT Pam Ribet <br /> NAME: <br /> ---- --- -------------------------- <br /> Lawson Insurance Group,Inc. aHONN Ext: 919-846-2090 ext 203 p No, 919-846-2438 <br /> 6512-101 Six Forks Rd. E-MAIL ADDRESS: pam.ribet@lawsonins.com <br /> Raleigh, NC 27615 INSURER(SLAFFORDING COVERAGE NAIC# <br /> INSURERA: Nationwide Mutual Insurance Company 23787 <br /> INSURED INSURERB: NorGUARD Insurance Company _ 25844 <br /> ProNet Systems, Inc. INSURERC: AIG Specialty Insurance Company <br /> 3200 Glen Royal Road INSURER D: <br /> .Suite 107 INSURER E: <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 /> 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 /> X COMMERCIAL GENERAL LIABILITY yACP2212994383 02/22/201902/22/2020 EACH OCCURRENCE $ 1,000,000 <br /> A CLAIMS-MADE ®OCCUR DAMAGE TO RENTED 100,000 <br /> PREMISES Ea occurrence $ <br /> It. Contractual Liability MED EXP(Any one person) $ 5,000 <br /> A Contractor's Enhancement PERSONAL BADVINJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> POLICY®JET LOC PRODUCTS-COMP/OPAGG $ 2,000,000 <br /> C OTHER: Core Cyber 1000 Master Contract IFI551241 04/28/2019 04/28/2020 Aggregate $ 1,000,000 <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 /> UMBRELLA LIAB X OCCUR ACP 2212994383 02/22/2019 02122120201 EACH OCCURRENCE $ 4,000,000 <br /> A X EXCESS LIAR CLAIMS-MADE AGGREGATE $ 4,000,000 <br /> DED X I RETENTION$ None $ <br /> WORKERS COMPENSATION PRWC900559 041031201904102/2020 STATUTE ERH <br /> AND EMPLOYERS'LIABILnY Y/N <br /> ANYPROPRIETOR/PARTNER/EXECUTIVE <br /> B E.L.EACH ACCIDENT $ 1,000,000 <br /> OFFICER/MEMBEREXCLUDED? 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 I Installation Floater$75,000. Limit <br /> A Commercial Inland Marine ACID 2212994383 02/22/2019 02/22/2020 Contractors Equip- 22,250. Limit <br /> All Job Sites of the Insured $500./$1000. Ded respectively <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 (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-Mail: tcomar@orangecountync.gov <br /> E-Mail: adorman@orangecountync.gov AUTHORIZED REPRESENTATIVE <br /> E-Mail: acornetto@orangecountync.gov ; <br /> E-Mail: patf@pronetsystemsnc.com <br /> '©1588-201 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />