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HomeMy WebLinkAbout2023-440-E-AMS-ProNet Systems-WCOB replace DMP with resideoDocuSign Envelope ID: 0F249D97-865F-475E-B914-E17D0D0EECCF DocuSign Envelope ID: 0F249D97-865F-475E-B914-E17D0D0EECCF DocuSign Envelope ID: 0F249D97-865F-475E-B914-E17D0D0EECCF DocuSign Envelope ID: 0F249D97-865F-475E-B914-E17D0D0EECCF DocuSign Envelope ID: 0F249D97-865F-475E-B914-E17D0D0EECCF DocuSign Envelope ID: 0F249D97-865F-475E-B914-E17D0D0EECCF DocuSign Envelope ID: 0F249D97-865F-475E-B914-E17D0D0EECCF DocuSign Envelope ID: 0F249D97-865F-475E-B914-E17D0D0EECCF 8/16/20238/18/2023 DocuSign Envelope ID: 0F249D97-865F-475E-B914-E17D0D0EECCF 8/16/2023 8/17/2023 8/17/2023 8/18/2023 8/18/2023 DocuSign Envelope ID: 0F249D97-865F-475E-B914-E17D0D0EECCF DocuSign Envelope ID: 0F249D97-865F-475E-B914-E17D0D0EECCF DocuSign Envelope ID: 0F249D97-865F-475E-B914-E17D0D0EECCF DocuSign Envelope ID: 0F249D97-865F-475E-B914-E17D0D0EECCF DocuSign Envelope ID: 0F249D97-865F-475E-B914-E17D0D0EECCF DocuSign Envelope ID: 0F249D97-865F-475E-B914-E17D0D0EECCF Ken Lawson Jr SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 06/20/2023 Lawson Insurance Group, Inc. 6512 Six Forks Rd # 101 Raleigh NC 27615-6561 Leslie McCoy 919-846-2090 ext 202 919-846-2438 leslie.mccoy@lawsonins.com ProNet Systems, Inc. 3200 Glen Royal Rd Raleigh NC 27617-7419 Nationwide Mutual Insurance Company 23787N Nationwide Mutual Fire Insurance Company Travelers A 6 6 6 Y Y ACPGLO2252994383 02/22/2023 02/22/2024 1,000,000 100,000 5,000 1,000,000 2,000,000 2,000,000 B 6 6 6 6 NONE ACPCAA2252994383 02/22/2023 02/22/2024 4,000,000 4,000,000 C Y Y UB0S866703 04/28/2023 04/28/2024 6 1,000,000 1,000,000 1,000,000 Orange County is included as additional insured (CG 20 33) 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). P.O. Box 8181 Hillsborough NC 27278 Orange County DocuSign Envelope ID: DDCA4666-4256-4C66-864C-BBC66074BF16DocuSign Envelope ID: 0F249D97-865F-475E-B914-E17D0D0EECCF DocuSign Envelope ID: DDCA4666-4256-4C66-864C-BBC66074BF16DocuSign Envelope ID: 0F249D97-865F-475E-B914-E17D0D0EECCF DocuSign Envelope ID: DDCA4666-4256-4C66-864C-BBC66074BF16DocuSign Envelope ID: 0F249D97-865F-475E-B914-E17D0D0EECCF Form_SCTNID_CTGRY.XX05165241_OTHER <docindex><index>OTHER</index></docindex> Policy number: 05786709 Underwritten by: Progressive Southeastern Ins Co NAIC Number: 38784 Page of 1 2 June 20, 2023 BROWN PHILLIPS INS 401 S LIMESTONE ST GAFFNEY, SC 29340 1-919-874-0405 Certificate of Insurance Certificate Holder …………………………………………………………………………………………………………………………………………………………………………… Orange County PO Box 8181 Hillsborough, NC 27278 Insured Agent ……………………………………………………………………………………………………………………………………………………………………………PRONET SYSTEMS INC 3200 GLEN ROYAL RD STE 107 RALEIGH, NC 27617 BROWN PHILLIPS INS 401 S LIMESTONE ST GAFFNEY, SC 29340 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. Liability coverage may not apply to all scheduled vehicles. Policy Effective Date: Policy Expiration Date: ……………………………………………………………………………………………………………………………………………………….. Jan 3, 2024Jan 3, 2023 Insurance coverage(s) Limits ………………………………………………………………………………………………………………………………………………………..Bodily Injury/Property Damage $1,000,000 Combined Single Limit ………………………………………………………………………………………………………………………………………………………..Any Auto Bodily Injury/Property Damage $1,000,000 Combined Single Limit ………………………………………………………………………………………………………………………………………………………..Uninsured/Underinsured Motorist $1,000,000 Combined Single Limit ………………………………………………………………………………………………………………………………………………………..Uninsured Motorist Property Damage (included in combined single limit w/$100 Ded) Description of Location/Vehicles/Special Items Scheduled autos only……………………………………………………………………………………………………………………………………………………….. 2006 FORD 1FTRF12WX6NA28557 F150 Comprehensive $500 Ded Collision $1,000 Ded ……………………………………………………………………………………………………………………………………………………….. 2014 JEEP 1C4RJFCG7EC272289 GRAND CHEROKEE Comprehensive $500 Ded Collision $1,000 Ded ……………………………………………………………………………………………………………………………………………………….. Stated Amount 2017 FORD T-250 TRANSIT V 1FTYR2YG3HKA41115 $27,000 Comprehensive $500 Ded Collision $1,000 Ded ……………………………………………………………………………………………………………………………………………………….. 2007 FORD 1FTNE14W37DB26903 ECONO/CLUB WGN Comprehensive $500 Ded Collision $1,000 Ded 4 Continued DocuSign Envelope ID: DDCA4666-4256-4C66-864C-BBC66074BF16DocuSign Envelope ID: 0F249D97-865F-475E-B914-E17D0D0EECCF <docindex><index>OTHER</index></docindex> Policy number: 05786709 PRONET SYSTEMS INC Page of 2 2 ……………………………………………………………………………………………………………………………………………………….. 2019 JEEP 1C4RJFAG2KC565077 GRAND CHEROKEE Comprehensive $500 Ded Collision $1,000 Ded Please be advised that the certificate holder will not be notified in the event of a mid-term cancellation. Form 5241 (05/16) DocuSign Envelope ID: DDCA4666-4256-4C66-864C-BBC66074BF16DocuSign Envelope ID: 0F249D97-865F-475E-B914-E17D0D0EECCF