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Home My WebLink About2018-587-E AMS - ProNet DA access DocuSign Envelope ID:6DC306FA-8025-42FD-A351-5AEB1A82A376 10. Non Appropriation: Provider acknowledges that County is a governmental entity, and the validity of this Agreement is based upon the availability of public funding under the authority of its statutory mandate. In the event that public funds are unavailable and not appropriated for the performance of County's obligations under this Agreement, then this Agreement shall automatically expire without penalty to County immediately upon written notice to Provider of the unavailability and non-appropriation of public funds. IN WITNESS WHEREOF,Orange County and the Provider have signed this Agreement, effective as of the day first written above. ORANG � 7 Y Y; PROVID�RSigned by: Lwu By: By: a 0,U Department H'e'ctor Title: 3JFL16650592A4F5... 200 S. Cameron St. Alan Jelley FF P.O.Box 8181 3200 Glen Royal Rd Suite 107 Hillsborough,NC 27278 Raleigh,NC 27617 i i 1 i I 1 Revised 10/17(Mgr appry 5k 6/18) 3 DocuSign Envelope ID:6DC306FA-8025-42FD-A351-5AEB1A82A376 PROGREUME' BROWN PHILLIPS INS COMMERC IAL 4940-B WINDY HILL DR RALEIGH,NC 27609 1-919-874-0405 Policy number: 05786709-1 Underwritten by: PROGRESSIVE SOUTHEASTERN INS CO July 6,2018 Page 1 of 2 Certificate of Insurance Certificate Holder ORANGE COUNTY PO BOX 8181 HILLSBOROUGH, NC 27278 Insured Agent ..................................................................................................................................................................................................... PRONET SYSTEMS INC BROWN PHILLIPS INS 3200 GLEN ROYAL RD STE 107 4940-B WINDY HILL DR RALEIGH, NC 27617 RALEIGH, NC 27609 This document certifies that insurance policies identified below have been issued by the designated insurer to the insured named above for the period(s)indicated. This Certificate is issued for information purposes only. It confers no rights upon the certificate holder and does not change, alter, modify, or extend the coverages afforded by the policies listed below. The coverages afforded by the policies listed below are subject to all the terms, exclusions, limitations, endorsements,and conditions of these policies. ............................................................................................................................................................................. Policy Effective Date: Dec 31,2017 Policy Expiration Date: Dec 31,2018 Insurance coverage(s) Limits ............................................................................................................................................................................. BODILY INJURY/PROPERTY DAMAGE $1,000,000 COMBINED SINGLE LIMIT ......................................................................................................................................................................::.::.. COMBINED UM/UIM BI $1,000,000 COMBINED SINGLE LIMIT .......................................................................................................................................................................:..... ANY AUTO BODILY INJURY/PROPERTY DAMAGE $1,000,000 COMBINED SINGLE LIMIT Description of Location/Vehicles/Special Items Scheduled autos only ............................................................................................................................................................................. 2003 FORD ECONO/CLUB WGN 1 FTNE241-63HB56220 UNINSURED MOTORIST PROPERTY DAMAGE $1,000,000 COMBINED SINGLE LIMIT W/$100 DED COMPREHENSIVE $500 DED COLLISION $1,000 DED ............................................................................................................................................................................. 2006 FORD F150 1 FTRF12WX6NA28557 UNINSURED MOTORIST PROPERTY DAMAGE $1,000,000 COMBINED SINGLE LIMIT W/$100 DED COMPREHENSIVE $500 DED COLLISION $1,000 DED ............................................................................................................................................................................. 2006 JEEP COMMANDER 1J8HG58286C245131 UNINSURED MOTORIST PROPERTY DAMAGE $1,000,000 COMBINED SINGLE LIMIT W/$100 DED COMPREHENSIVE $500 DED COLLISION $1,000 DED ................................................................................................................................................................................. 2013 FORD TRANSIT CONNECT NMOLS7DN6DT155594 UNINSURED MOTORIST PROPERTY DAMAGE $1,000,000 COMBINED SINGLE LIMIT W/$100 DED Continued DocuSign Envelope ID:6DC306FA-8025-42FD-A351-5AEB1A82A376 Policy number: 05786709-1 Page 2 of 2 COMPREHENSIVE $500 DED COLLISION $1,000 DED ............................................................................................................................................................................... 2014 JEEP GRAND CHEROKEE 1 C4R1FCG7EC272289 UNINSURED MOTORIST PROPERTY DAMAGE $1,000,000 COMBINED SINGLE LIMIT W/$100 DED COMPREHENSIVE $500 DED COLLISION $1,000 DED ................................................................................................................................................................:............ 2016 MERCEDES-BENZ GLE400 41GDA5GB9GA678426 Stated Amount $52,000 UNINSURED MOTORIST PROPERTY DAMAGE $1,000,000 COMBINED SINGLE LIMIT W/$100 DED COMPREHENSIVE $500 DED COLLISION $1,000 DED ............................................................................................................................................................................. 2017 FORD T-250 TRANSIT V 1 FTYR2YG3HKA41115 Stated Amount $27,000 UNINSURED MOTORIST PROPERTY DAMAGE $1,000,000 COMBINED SINGLE LIMIT W/$100 DED COMPREHENSIVE $500 DED COLLISION $1,000 DED ............................................................................................................................................................................. 2007 FORD ECONO/CLUB WGN 1 FTNE14W37DB26903 UNINSURED MOTORIST PROPERTY DAMAGE $1,000,000 COMBINED SINGLE LIMIT W/$100 DED COMPREHENSIVE $500 DED COLLISION $1,000 DED Certificate number 18718NET709 Please be advised that the certificate holder will not be notified in the event of a mid-term cancellation. Form 5241(10/02) DocuSign Envelope ID:6DC306FA-8025-42FD-A351-5AEB1A82A376 ® DATE(MM/DDIYYYY) AC CERTIFICATE OF LIABILITY INSURANCE 04/07/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Amy H.Paschal Ken B.Lawson,Jr. A/C,N Ext: 919-846-2090 ext 105 ac No: 919-846-2438 Ken Lawson Jr.Agency EMAIL pas nationwide.com g Y ADDRESS: P @ 6512-101 Six Forks Road INSURERS AFFORDING COVERAGE NAIC# Raleigh,NC 27615 INSURERA Nationwide Mutual Insurance Company 23787 INSURED INSURERB: NorGUARD Insurance Company 25844 ProNet Systems,Inc. INSURER : 3200 Glen Royal Road INSURER D: Suite 107 INSURER E: Raleigh, NC 27617 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR D WVD POLICY NUMBER MM/DD MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY y ACP GLO 2292994383 02/22/201702/22/2018 EACH OCCURRENCE $. 1,000,000 IN]OCCUR DAMAGE TO RENT CLAIMS-MADE ED PREMISES Ea occurrence 100,000 $ � • Contractual Liability MED EXP(Anyone person) $ 5,000 • Contractor's Enhancement PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY®JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ A X UMBRELLA LIAB IV I OCCUR Y ACP CAF 229994383 02/22/2017 02/22/2018 EACH OCCURRENCE $ 4,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 4,000,000 DED I X I RETENTION$ none $ B WORKERS COMPENSATION PRWC836165 04/0312017 04/03/2018 X STATUTE ORH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 1,000,000 OFFICERlMEMBEREXCLUDED7 N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Tools and Equipment Installation Floater $75,000.Limit A Commercial Inland Marine ACP CIM 2292994383 02/22/2017 02/22/2018 Contractors Equip $22,250.Limit All Job Sites of the Insured $500./141000. Died Respectively DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Orange County is included as additional insured and Waiver of Subrogation applies per Blanket Contractors Enhancement Endorsement CG 72 88 under the general liability policy(please refer to attachments). The Umbrella/Excess Liability policy is"follow form". Blanket Waiver of Subrogation also applies to the workers compensation policy(please refer to attachments). CERTIFICATE HOLDER CANCELLATION Orange County P.O.Box 8181 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Hillsborough,INC 27278 ACCORDANCE WITH THE POLICY PROVISIONS. E-Mail: tcomar @orangecountync.gov AUTHO ,AD REPR ENTATJVE E-Mail: anitaj @pronetsystemsnc.com r ty >� } E-Mail: patf@pronetsystemsnc.com *t '' - - @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD