Orange County NC Website
Browse       Search
DocuSign Envelope ID: 179A5753-48DE-4001-9B49-426397E056F6 <br /> AeC)REP CERTIFICATE OF LIABILITY INSURANCE FGATE{MMIDDIYYYY) <br /> 05/2312019 <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(les)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 Ileu of such endorsement(s). <br /> CONTACT Pam Ribet <br /> PRODUCER NAME; <br /> Lawson insurance Group,Inc. PH°NE r,j. 919-846-2090 ext 203 919-846-2438 <br /> 6512.101 Six Forks Rd. n DRESS: parn.rlbet@lawsonins.com <br /> Raleigh,NC 27615 INSUREf{5 AFFORDING COVERAGE NAtc 0 _ <br /> INSURER A: Nationwide Mutual Insurance Company 23757 <br /> INSURED INSURERB; NorGUARD Insurance Company 25844 <br /> ProNet Systems,Inc. INsuRcR c: AIG Specialty Insurance Company <br /> 3200 Glen Royal Road INSURER 0: <br /> Suite 107 INSURERE: <br /> Raleigh,NC 27617 INSURE RF: <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 13 SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INS1t ADDL S aR POLICY EFF POLICY EXP LIMITS <br /> LT TYPE OF INSURANCE INSD WVn POLICYNUMRER MMrDO MMrDDN <br /> X COMMERCIALGENERALLIAEILITY ,Y ACP2212994383 02122I20190212212020 EACH OCCURRENCE $ 1,000,000 <br /> A CLAIMS-MADE OCCUR PREMISE Ea occu Dmnaal S 100-000 <br /> Contractual Liability MED EXP(Any one person $ 6,000 <br /> ](' Contractor's Enhancement PERSONAL aA7VINJURY S 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000 <br /> x POLICY I PRO- <br /> POLICY LOC PRODUCTS-COMPIOPAGG $ 2,000,000 <br /> C OTHER:Core Cyber 1000 I I Master Contract IF1551241 0412812019 1 04128/2020 Aggregate $ 1,000,000 <br /> A1fTOM1}BI4ELIA9ELI7Y Ea accideat5lNGLE LIMIT $ <br /> ANY AUTO BODILY INJURY[Per pers(n] $ <br /> OWNED SCHEDULED BODILY INJURY{Per a=ldent) $ <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE S <br /> AUTOS ONLY AUTOS ONLY Per aoddent <br /> S <br /> X UMBRELLALIAB ]iE' OCCUR ACP2212994383 021221201902/2212020 EACHOCCURRENCE S 4,000,000 <br /> A .X, EXCESS LIAR CLAIMSMADE AGGREGATE $ 4,000,000 <br /> DED .' RETENTIONS None I S <br /> WORKERS COMPENSATION PRWC900559 04/031201904/0212020 X I STATUTE I I ERH <br /> AND EMPLOY ERS'LIABILrrY <br /> 0 ANYPROPRIETCRPARTNERIEXECUnVE YIN NIA E.L EACH ACCIDENT S 1,000,000 <br /> OF ay <br /> (Mandatory In Mill E.L.DISEASE-EAEAhPLOYEE $ 1,000,000 <br /> IFyas describe order E.L❑ISEASE-POLICY LIMIT $ 1,000,000 <br /> DESCRIPTION Of OPERATIONS below <br /> Tools and Equipment Installation Floater 75,000. Limit <br /> A Commercial Inland Marine ACP 2212994383 02/221201802122/2020 Contractors Equip- 22,250. Limit <br /> All Jab Sites of the insured $500.1$1000. Ded respectively <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional RemarRs.Sehed"la,may be attached Y 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 liabifity policy(please refer to attachments). The Umbre€latExcess 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.�.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@orangecountyne.gov AUTHORIZED REPRE;w: <br /> E-Mail: acornetto@orangecountync.gov <br /> E-Ma€l: atf ronets stemsnc.com -; <br /> © 88.201 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />