Orange County NC Website
Browse       Search
DocuSign Envelope ID:4BC6834A-DA95-4332-B030-296E39B121C8 <br /> ,�co►ro0 CERTIFICATE OF LIABILITY INSURANCE nATE(MNIf°D,YYYY, <br /> 02/2212019 <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(iesl 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 CN"EACT Anny H.Paschal <br /> Lawson Insurance Group,Inc. PHONE 919446-2090 ext 105 A Nu: 979.846-2438 <br /> 6512-101 Six Forks Rd. E-VA(L ADDRESS' arny.paschal@tawsonins.com <br /> Raleigh,NC 27615 INSURERS AFFORDING COVERAGE NMI <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 I14 SURER E- <br /> Raleigh,NC 27617 INSURER r: <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. NOTWfTI-ISTANDING 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 /> LLTR TR TYPE OF INSURANCE �DL SUBR POLICY NUMBER Mmo POLICY EFF M"foo POUCYfJIP ym LIMrrS <br /> X COMMERCfALGENERALLL48ILm y ACP2212994383 02t22/20190212212020 EACH OCCURRENCE S 1,000,000 <br /> -DANME TO RENTED <br /> A CLAIMS-MADE NI OCCUR PREMISES Eeorx�lrrence i 100,000 <br /> X Contractual Liability MED EXP(Anyone pers f 5,000 <br /> X Contractor's Enhancement PERSONAL&ADV IWURY $ 1,000,000 <br /> GEML AGGREGATE UM IT APPLIES PER-, GENERAL AGGREGATE S 2,000,00D <br /> X POLICY NC JECT LOC PRODUCTS-COMP/OP AGG i 2,000,000 <br /> C OTHER:Core Cyber 1000 Master Contract IFI551241 04/2812018 0412812019 Aggregate s 1,000,000 <br /> AUTOMOBILE LIABILITY COMB]NEO SINGLE LIMIT i <br /> f.sExideni <br /> ANYAUTO BODILY INJURY(Per person) S <br /> OWNED SCHEDULED BOMLY94JURY Per accident <br /> AUTOS ONLY AUTOS ( 3 S <br /> HIRED NON-OWNED PROPERTY DAMAGE <br /> AUTOS ONLY ALTOS ONLY Per aociderd ; <br /> S <br /> X UMBRELLA LIAM X OCCUR ACID 2212994383 02J2212019 0212212D20 EACH OCCURRENCE 5 4,000,000 <br /> A X EXCESS I" CLAIMS-MADE AGGREGATE $ 4,000,000 <br /> DED TX RETENTION S None = <br /> WORKERS <br /> oo KERSoCOMPENSAeum YEN PRWC900559 041031201,9 04102J2019 X STATUTE ERH- <br /> B ANYPROPRIETQ"ARTNERIEXEC DINE <br /> OFFICER(MEMBER EXCLUDED? I Yj NIA EL EACH ACCIDENT $ 1,000,000 <br /> (Mandalory In NH) E.L DISEASE-EA EMPLOYEE $ 1,000,000 <br /> If yes,dascas under <br /> DESCRIPTiDN OF OPERATIONS below I E.L DISEASE-POLICY LIMIT $ 1,000,000 <br /> Tools and Equipment Installation Floater 75,000.Limit <br /> A Commercial Inland Marine ACP 2212994383 02/22/2019 02122/2020 Contractors Equip 22,250.Limit <br /> All Job Sites of the Insured 1 $500J$1000.Ded r pectively <br /> DES CRIP-RDN OF OPERATIONS 1 LOCATIONS E VEHICLES IACORO IA1.Additional Remarks Schedule,may be aHached if more space ie 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 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.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: AUTMO�R 'DREPR ENTA <br /> E•Mail: anitaj@pronetsystemsnc.com <br /> E-Mail: payApronetsystemsnc.com �C <br /> Q 198112015 ACORO CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered Lnrrks of ACORD <br />