Orange County NC Website
DocuSign Envelope ID: 3B2F6DD9-152F-419D-9A89-95AF3FCEEC72 <br />INSURED <br />200 South Cameron Street <br />Hillsborough, NC <br />A:Tokio Marine America Insurance <br />B <br />C <br />D <br />E <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 <br />LTR <br />TYPE OF INSURANCE <br />ADDLBRJ <br />INSR <br />M <br />- <br />POLICYNUMBER <br />POLICY EFF <br />(MMIDO/YYYYI <br />POLICY —EXP <br />(MM/DDIYYYY) <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000,000 <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS-MADE F---1 <br />I A I OCCUR <br />X <br />CPP6407433 <br />0512612014 <br />0612612015 <br />pR 3ET0-RERTEU­-- <br />EMISES (Ea occurrence) <br />- <br />$ 100,0 D( <br />MED EXP (Any one persc n) <br />$ 5,00( <br />PERSONAL &ADVINJUIRY <br />S 1,000,00C <br />GENERAL AGGREGATE <br />$ 2,000,0 OC <br />GEN1- AGGREGATE LIMIT APPLIES PER: <br />- 1 <br />A - I POLICYF— I PI ACOT- F-] LOC <br />PRODUCTS - COMP/OP AGG <br />— <br />$ <br />$ <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />$ <br />BODILY INJURY (Per person) <br />$ <br />ALL OWNED AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />SCHEDU LED AUTOS <br />PROPERTY DAMAGE <br />(Per accident) <br />$ <br />HIRED AUTOS <br />$ <br />NON-0OMED AUTOS <br />$ <br />X <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ 3,000,0 DO <br />A <br />EXCESS LIAB <br />CLAIMS-MADE <br />X <br />CU6407430 <br />06/26/2014 <br />05126/2015 <br />AGGREGATE <br />3,000,000 <br />DEDUCTIBLE <br />X <br />RETENTION $ 10,000 <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETOR/PARTNER/EXECUTIVE r— <br />OFFICERIMEMBER OCCLUDED? <br />NIA <br />IWC STATU- 3TH- <br />ITORY LIMITS <br />E.L. EACH ACCIDENT <br />$ <br />DISEASE - EA EMPLOYEE <br />$ <br />(Mandatory In NH) <br />IfrE.L. <br />es, under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY OMIT <br />$ <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Addition.[ Remarks Schedule, if �s <br />With respect to the insured's leased premises at 200 South SaMepr7o'n"Met <br />Hillsborough NC, the certificate holder is included as Additional Insured <br />subject to a wr3.tten contract or agreement executed prior to a loss. <br />HR Manager <br />Morinaga America Foods, Inc. <br />P.O. Box 1359 <br />Hillsborough, NC 27278-1369 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />(0 1988-2009 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD <br />