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HomeMy WebLinkAboutInsurance Certificate: Johnson Controls 212 345-5000 3/5/2013 5:28:43 PM PAGE 2/005 Fax Server 2013DWVY) 61 (MINILT ,acvR°® CERTIFICATE OF LIABILITY INSURANCE DATE 01052013 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 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 Marsh USA Inc. NAIxE. 411 E. Wisconsin Avenue PHONE FAX Nd Eat : A/C No Sane 1300 E-MAIL Mitmukee, Wl 53202 ADDRESS: AW:JCI.Cenrequest@marsh.mm INSURERS AFFORDING COVERAGE NAICa 011077--CAS-12-13' 12-13 INSURER A: Old Republic Insurance Cc 24147 INSURED INSURER B: Sentry Insurance A Mutual Cc 24966 Johnson Controls, Inc York International Corporation INSURER C: Indemnity Insurance Company Of North Amenea 43575 Attn: Corp. Risk Mgnt X-92 INSURER D : ACE American Insurance Conlpally 22667 P.O. Box 591 Mihvaukee, WI 53201 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: CHIfXM64021T(02 REVISION NUMBER:2 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. I~TR TYPE OF INSURANCE ADDLSUbN POUCYNUMBER MWDDDV/VYYY MWOD%EYYY LIMITS INSR MD A GENERAL LIABILITY MWZY59837 101012012 10012013 EACH OCCURRENCE $ 10,000000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea ..I $ 10,000,000 CLAIMS-MADE M OCCUR MED EW(My one person) $ 50,000 X Contractual Liability PERSONAL 6ADV INJURY $ 10,000,000 X XCU Included GENERALAGGREGATE $ 30,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTSCOMPIOPAGG S INC IN GEN AGG X POLICY P" LOC $ FCT B AUTOMOBILEUABILITY 90-04606-01 104012012 10/012013 COMBINED SINGLE LIMIT 5,000,000 (E. accd.t) B JX ANYAUTO 9004806-02(MA) 10012012 10,912013 BODILY INJURY ALL OWNED SCHEDULED BODILY INJURY(Persenderd) S AUTOS AUTOS HIRED AUTOS % NON,OWNED PROPERTY DAMAGE $ AUTOS eracudem. $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ BED RETENTION $ C WORKERS COMPENSATION WLRC17124335(ADS -See page 2) 101012012 10012013 % We STATU- oTH LIM IS AND EMPLOYERS' LIABILITY D ANY PROPRIETORIPARTNERIEXECUnVE YIN WLRG1T124347 (CA, AZ, MA) 10912012 10912013 EL EACH ACCIDENT S 5'000'0(10 D OFFICEMMEMBEREXCLUDEDT ❑N N/A SCFC47124360 "1) 10,0112012 10912013 5,000,000 (Mandator, in NH) E.L DISEASE - F EMPLOYE $ D DESCRIPTION OF OPERATIONS below WCUC47124372 (Excess WC - OH, WA) 10.7112012 10912013 E. L. DISEASE-POLICY LIMIT $ 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (Attach ACORD 101, Addltlonal Ramarks Schudulo, If morn space Is required) The City of Ashland, Oregon and its Heeled officals, officers and employees are induced as additional insured per tie attached. CERTIFICATE HOLDER CANCELLATION 01yof Ashlad SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 East Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Ashland, OR 97502 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE W March USA Inc. Manashi Mukherjee 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 212 345-5000 3/5/2013 5:28:43 PM PAGE 3/005 Fax Server AGENCY CUSTOMER ID: 011077 LOC#: Milwaukee AC R ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh USA Inc. Johnson Cornmis, Inc York International Corporatbn POLICY NUMBER Am: Corp. Risk Mgmt X-92 P.O. Box 591 Milwaukee, WI 59201 CARRIER NAIL CODE EFFELYIVE GATE; ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance WORKERS COMPENSATION Workers Compensa4on'AOS' Policy includes coverage for he following stales: AK AL, AR CO, CT, DC, DE. FL. GA HI. A. ID, IL, IN, KS, KY, IA MD, ME, MI, MN, MO, MS, MT, NC, NE NH, NJ, NM, NV, NY, OK, OR, PA, RL SC, SD, TN, TX, UT, VA, VT, WV PRIMARY COVERAGE The General Liability and Automobile Liability policies are primary and not excess of or contributing with other Insurance or selHnsurance, where required by writen lease orwdtten contract For General Lability, his applies to both ongoing and completed operations. WAIVER OF SUBROGATION The General Liability, Automobile Liability, Workers Compensation and Employers Lability poldes include a waiver of subrogation in favor of the certificate holder and additional insureds to the extent required by written contract. ADDITIONAL INSURED -AUTOMOBILE LIABILITY The Automobile Liability policy, if required bywrtan contract, includes coverage for Additional Insureds as required by such written contract ADDITIONAL INSURED - GENERAL LIABILITY ' For General Ur i6ly, it required by written contract the following are induced as additional insureds, as required pursuant to a written contract with a named insured, peratached Policy Endorsements A2 and A2A: THE CERTIFICATE HOLDER LISTED ON THIS CERTIFICATE OF LIABILITY INSURANCE, AND EACH OTHER PERSON OR ORGANIZATION REQUIRED TO BE INCLUDED AS AN ADDITIONAL INSURED PURSUANT TO A WRI7TEN CONTRACT WITH THE NAMED INSURED. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 212 345-5000 3/5/2013 5:28:43 PM PAGE 4/005 Fax Server )L 10 (12/06) OLD REPUBLIC INSURANCE COMPANY ADDITIONAL INSURED -GIAINERS, LESSEES OR CONTRACTORS -SCHEDULED PERSON OR ORGANIZATION - ENDORSEMENT X82 Named Insured Endorsement Number Johnson Cantrds, inc. Policy Prefix ~Pol ey Number Policy Period Effective Date of Endorsement MWZY 1!59837 10101=12 to 10x0 i12f113 Issued By Old Republic Insurance Company_ THIS ENDORSEMENT.CHANGES THE POLICY. PLEASE READ :T CAREFULLY. This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE, Name Of Additional Insured Person(s) Or Organizatfon(a): If mqubad by conlmi:% the parson or arprilzadon Bated on the cedillcete of insurance as addillonal "urad, and each o8narpereon or orpw lb-swm regdmd to be Included as en addi0onal Insured pursuantto a =treat wah a named Insured. Location(s) Of Covered Operations: As requled by contract Informattan required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section tl - Who Is An Insured Is amended to include as an additional insured the person(s) or organization(s) shown in The Schedule, but only with respect to liability for "twdily Injury", "property damage" or 'personal and adverlising lnjury" caused solely by. 1. Your acts or omissions; or 2. The acts or omissions of those acting on your hehotf; In the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. a. With respect to the insurance afforded to these addltional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: All work, including materials, parts or equipment furnished In connection, with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional Insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any parson or organization other than another contractor or subcontractor engaged in performing operatlons for a principal as a part of the same project. GL 2139 001 1032 NWZY 591137 h:mson Controls, Ina 10/MV12 • 1tA IIZD13 212 345-5000 3/5/2013 5:28:43 PM PAGE 5/005 Fax Server IL -,(a ,(12/ 06) OLD REPUBLIC INSURANCE COMPANY _ ADDITIONAL INSURED -SSWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERA71ONS - ENDORSEMENT AZA Named insured ' Endorsement Number Johnson coneots, Inc. Policy Pnafl% Policy Number Policy Period Etfeclive Date of Endorsement Mwzy 69as7 110101r2ot2to10101rzot3 Issued By -T.-_.- Old Re"tillo tnsurnnce ConnpaW THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIAHI'JTY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): If regttlmd by contract, the person or oganenrtlon llstedon the corUlicate of inairorrce as additional insured. and each other person or organize cis n3quGed to be inaLdad as on additional insured pamam to a contract with a named Insured. Loontion And Desuriptlon Of Completed Operations: As required by contract Information required to complete this Schedule, if not shown above, will be shown In the Declarations. Section fl - Who Is Air tnsured Is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect tD Ilabllity for "bodily Injury" or "property damage" caused solely by 'your work" at the location designated and described In the Schedule of this endorsement performed for that additional insured and included in the 'produces completed operations hazard'- GL 289 0021012 MWZY59637 Johnson Fontrcrs, Inc. 10(01/2012.10/01/2013