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Insurance Certificate: Johnson Controls (2)
ACORO CITY RECORDER YYYY) ® CERTIFICATE OF LIABILITY INSURANCE avDATE15rm1 12013 ~1 THIS CERTIFICATE IS ISSUED AS A NATTER 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. NAME: 'p 411 E. WISCOn$In Avenue PHONE _ IaC No): Slate 1600 E-MAIL MMaukee, Wl 53202 ADDRE S: Adn: JCI.CertRquest@marsh.wm INSURER(S) AFFORDING COVERAGE NAIC r 011077-CAS-12-13' 12-13 INSURER A: Old Republic Insurance CO 24147 INSURED Johnson Controls, Inc. INSURER B Sentry Insurance A Mutual Co 24988 York lntennational Corporation INSURER C, Indemnity Insurance Company Of North America 43575 Ann: Corp. Risk Mgmt. X-92 INSURER D : ACE American Insurance Company 22667 P.O. Box 591 Milwaukee, WI 53201 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: CHI-004640217-01 REVISION NUMBER:I 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 CONDI TION 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 INSR SUOR POLICY NUMBER Mrst"IYYYY MPOLICY YEXP UNITS ADOL LTR A GENERAL LUIBIDTY MWZY59837 10/0112012 10101/2013 EACH OCCURRENCE $ 10,000,000 DAMACTE T(YFFEAf€D 10.000.000 XWMMERCIAL GENERAL LIABILITY PREMI EEEao¢unence $ _ CLAIMS-MADE E OCCUR MED EXP(My one person) $ 50.000 X Contractual Liability PERSONAL a ADV INJURY $ 10.000'000 X XCU Included _ GENERAL AGGREGATE $ 30,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG $ INC IN GEN AGG X POLICY PRO- LOf, $ B AUTOMOBILE LIABILITY 90.04606-01 10/01/2012 1010112013 COMBINED SINGLE LIMIT 51000,000 Ea accident _ B X ANY AUTO 90-04606-02 (MA) 10101/2012 10/0112013 BODILY INJURY (Pur Person) $ ALL OWNED SCHEDULED BODILY INJURY (Per..d.N) $ X AUTOS X NAUTOS ON-OWWED PROPERTY DAMAGE $ 1 HIRED AUTOS _ AUTOS Per accident) S UMBRELLA LAB OCCUR EACH OCCURRENCE EXCESS UAB CLAIAISMADE AGGREGATE DED HETENTION$ 5 C WORKERS COMPENSATION WLRC47124335 (ADS - See page 2) 10/0112012 10101/2013 WC STATU. OTH- AND EMPLOYERS' LIABILITY TOBYLNllTS_ D ANY PROPRIETOR/PARTNERIEXECUTIVE Y I N WLRC47124347 (CA, AZ, MA) 1010112012 10101/1013 E.L. EACH ACCIDENT $ 5,000,000 D OFFICER/MEMBER EXCLUDED? EN] NIA SCFC47124360 (W) 1010112012 10/01/2013 5,000,000 (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ _ D It yes descnoe under WCUC47124372 (Excess WC- OH, WA) 1010112012 10/0112013 E L. DISEASE - POLICY LIMIT $ 5'000'000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if mom space Is r umxl) The City of Ashland, Oregon and its elected offcais, officers and employees are included as additional insured per the abashed. CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn: Karl Olson THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 East Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97502 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjeeauaos.+ ~4..atc~uAde.x. ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 011077 LOC Milwaukee Ac0 ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh USA Inc. Johnson Controls, Inc. York International Corporation POLICY NUMBER Attn: Corp. Risk Mgml. X-92 P.O. Box 591 Milwaukee, WI 53201 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance WORKERS COMPENSATION Workers Compensabon'AOS' Policy includes coverage for the following states: AK, AL, AR, CO, CT. DC, DE, FL, GA, HL IA, ID. If-, IN. KS, KY, LA. MID, ME, MI, MN, NO, MS, NIT, NC, NE, NH, NJ. NIA. NV, NY. OK, OR, PA, RI, SC, SO, TN, TX, UT, VA, VT, WV PRIMARY COVERAGE The General Liability and Automobile Uability policies are primary and not excess of or contributing with other insurance or self-insurance, where required by written lease or written contract. For General Liability, this applies to both ongoing and completed operations. WAIVER OF SUBROGATION The Genera Liability, Automobile Liability, Workers Compensation and Employers Liability policies include a waiver of subrogation in favor of the ceNbcate holder and additona insureds to the extent required by written contract. ADDITIONAL INSURED-AUTOMOBILE LIABILITY The Automobile Liability policy, if required by written Contract, includes coverage for Additional Insureds as required by such written conVacl. ADDITIONAL INSURED- GENERAL LIABILITY For Genera Liability, if required by written contract, the following Be included as additional insureds, as required pursuant to a written contract with a named insured, per attached Policy Endorsements A2 and AM: 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 WRITTEN CONTRACT WITH THE NAMED INSURED. ACORD 101 (2008101 © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD IL 10 (12106) OLD REPUBLIC INSURANCE COMPANY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION - ENDORSEMENT A2 Named Insured Endorsement Number Johnson Controls. Ins. Policy Prefix Policy Number Policy Period Effective Date of Endorsement Mw" 59837 10/0112012 to 101012013 Issued By Old Repbllo insurance Cornparry THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): If required by conbaa the person or organlmtion Gated on the certificate of Insurance as addltlonel insured, and each other person or organization required to be MGuded as an additkual insured pursuant to a contract with a named Insured. Location(s) Of Covered Operations: Act required by conM=L Information required to complete this Schedule. If rot shown above, will be shown in the Declarations. A. Section it - 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 "bodily injury". "property damage` or 'personal and advertising injury" caused solely by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. B. With respect to the insurance afforded to these additional Insureds, the following additional exclusions apply. This insurance does not apply to "bodily Injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other tnan service, maintenance or repairs) to be performed by or on behalf of the additional Insureds) 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 person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. GL 2139 001 1012 NVM 50077 Johnson Controls, Inc. 14.0112012.1=112013 IL 10 (12106) OLD REPUBLIC INSURANCE COMPANY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS - ENDORSEMENT A2A Named Insured Endorsement Number Johnson ComnAs• Inc. Policy Prefix Policy Number Policy Period Effective Date of Endorsement mvr-y 59937 10101/2012 to 1WOM013 Issued By Old Republic Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): If required by contract, the person or organization Isted on the canlficate of Insurance as additional Insured, and each other parson or organization required to be Included as an additional Insured pursuant to a contract w0h o named Insured. Location And Description Of Completed Operations: As required by contact Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II - 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 "bodlly 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 "products-completed operations hazard". GL 289 0021012 MWZY59837 Johnson controls, Ina. 1WIM012-109U2013 0000907 SP 0045 -C01-P00901.1 City of Ashland Attn: Kari Olson 20 East Main Street Ashland, OR 97502 R$N