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DocuSign Envelope ID : 050BC302-6F40-4560-9353-5AEF9A7D2920
<br /> ACC?® DATE (MM/DD/YYYY)
<br /> CERTIFICATE OF LIABILITY INSURANCE 05/23/2019
<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 endorsement(s ) ,
<br /> PRODUCER CONTACT NAME : Pam Ribet
<br /> Lawson Insurance Group , Inc . aHCNN Ext : 919 -846 -2090 ext 203 No) : 919 -846 -2438
<br /> 6512-101 Six Forks Rd . A MAILDDRESS : Pam , rlbet@lawsonins . com
<br /> lawsonins . com
<br /> A
<br /> Raleigh , NC 27615 INSURER(S) AFFORDING COVERAGE NAIL #
<br /> INSURER A : Nationwide Mutual Insurance Company 23787
<br /> INSURED INSURER B : NorGUARD Insurance Company 25844
<br /> ProNet Systems , Inc . INSURER C : AIG Specialty Insurance Company
<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 POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE INSD WVD SUER POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS
<br /> X COMMERCIAL GENERAL LIABILITY y ACP 2212994383 02/22/2019 02/22/2020 EACH OCCURRENCE $ 1 , 000 , 000
<br /> A CLAIMS-MADE ® OCCUR DAMAGE (Ea occurrence $RENTED 100 , 000
<br /> PREMISESS
<br /> X Contractual Llabillty 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: GENERALAGGREGATE $ 2 , 000 , 000
<br /> a POLICY ® PE� LOC PRODUCTS - COMP/OP AGG $ 2 , 000 , 000
<br /> C OTHER: Core Cyber 1000 Master Contract IF1551241 04/28/2019 04/28/2020 Aggregate $ 11000 , 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 /> $
<br /> X UMBRELLALIAB ,' OCCUR ACP 2212994383 02/22/201902/22/2020 EACH OCCURRENCE $ 4, 000 , 000
<br /> A X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 4, 000 , 000
<br /> DED + i RETENTION $ None $
<br /> WORKERS COMPENSATION PRWC900559 04/03/2019 04/02/2020 STATUTE EERH
<br /> AND EMPLOYERS' LIABILITY YIN
<br /> ANYPROPRIETOR/PARTNER/EXECUTIVE
<br /> B N / A E. L. EACH ACCIDENT $ 1 , 000 , 000
<br /> OFFICER/MEMBER EXCLUDED?
<br /> (Mandatory in NH) E . L. DISEASE - EA EMPLOYEE $ 1 , 000 , 000
<br /> If yes, describe under 1 , 000 , 000
<br /> DESCRIPTION OF OPERATIONS below E . L. DISEASE - POLICY LIMIT $
<br /> Tools and Equipment Installation Floaterm $ 75 , 000 . Limit
<br /> A Commercial Inland Marine ACP 2212994383 02/22/2019 02/22/2020 Contractors Equip - 22, 250 . Limit
<br /> All Job Sites of the Insured $500J$ 1000 . Ded r pectively
<br /> DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101 , Additional Remarks Schedule, maybe 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 REPRESENTA E
<br /> E -Mail : acornetto@orangecountync . gov
<br /> E -Mail : patf@pronetsystemsne . com
<br /> © 88 -201 ACORD CORPORATION . All rights reserved .
<br /> ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
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