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HomeMy WebLinkAboutInsurance Certificate: Johnson Controls 7 ® DATE (MM/DD/YYYY) ACORL7 CERTIFICATE OF LIABILITY INSURANCE 02/0,/2016 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. NAME: PHONE FAX 411 E. Wisconsin Avenue A/c A/c No): Suite 1300 E-MAIL Milwaukee, WI 53202 ADDRESS: Attn: JCI.Certrequest@marsh.com INSURER(S) AFFORDING COVERAGE NAIC # 011077-Month-CAS-15-16 16Feb INSURER A : Old Republic Insurance Company 24147 INSURED INSURER B : North American Elite Insurance Company 29700 Johnson Controls,lnc. York International Corporation INSURER C : Indemnity Insurance Company of North America 43575 Attn: Corp. Risk Mgmt. X-92 INSURER D : ACE American Insurance Company 22667 P.O. Box 591 5757 N. Green Bay Ave. INSURER E : ACE Fire Underwriters Insurance Company 20702 Milwaukee, WI 53201 INSURER F COVERAGES CERTIFICATE NUMBER: CHI 006530946-01 REVISION NUMBER:O 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY MWZY305447 1010112015 10/01/2016 EACH OCCURRENCE $ 10,000,000 IIA-MAGE TO CLAIMS-MADE a OCCUR PREMISES (Ea occur ence $ 10,000,000 X Contractual Liability MED EXP (Any one person) $ 50,000 X XCU Included PERSONAL & ADV INJURY $ 10,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 30,000,000 POLICY ❑ PRO ❑ LOC I PRODUCTS - COMP/OP AGG $ INC IN GEN AGG X JECT OTHER $ D AUTOMOBILE LIABILITY ISA H08860373 1010112015 10/01/2016 COMBINED SINGLE LIMIT $ 5,000:000 ( Ed accident' X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per accident B X UMBRELLA LIAB X OCCUR UMB 2000252 00 10/0112015 10101/2016 EACH OCCURRENCE $ 5,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION $ $ C WORKERS COMPENSATION WLR C48591851 (AIDS - See page 2) 10/01/2015 10/01/2016 _qPER STATUTE OTH AND EMPLOYERS' LIABILITY D Y / N WLR C4859184A CA, MA 10/0112015 10/0112016 5,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE N ( ) E.L. EACH ACCIDENT $ E OFFICER/MEMBER EXCLUDED? ❑ N/A SCF 048591875 10/0112015 1010112016 5,000,000 (Mandatory in NH) (WI) E L DISEASE - EA EMPLOYEE $ D If yes, describe under WCU 048591863 (Excess WC - OH, WA) 10/01/2015 10/0112016 E.L. DISEASE - POLICY LIMIT $ 5,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) JCI Project Number: 6N580085, JCI Project Name: City of Ashland Carrier WT replacement, Customer PO Number: 675.08.19.00.602400, CITY OF ASHLAND is included as additional insured per the attached endorsements A2 and A2A. CERTIFICATE HOLDER CANCELLATION CITY OF ASHLAND 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 97520 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee.t~~ArAai~: 1c.+w, u @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 011077 LOC Milwaukee ACO ® ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh USA Inc. Johnson Controls, Inc. York International Corporation POLICY NUMBER Attn: Corp. Risk Mgmt. X-92 P.O. Box 591 5757 N. Green Bay Ave. CARRIER NAIC CODE Milwaukee, WI 53201 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 Compensation "AOS" Policy includes coverage for the following states: AK, AL, AR, AZ, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MD, ME, MI, MN, MO, MS, MT, NC, NE, NH, NJ, NM, NV, NY, OK, OR, PA, RI, 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 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 General Liability, Automobile Liability, Workers Compensation and Employers Liability policies 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 by written contract, includes coverage for Additional Insureds as required by such written contract. ADDITIONAL INSURED - GENERAL LIABILITY For General Liability, if required by written Contract, the following are included as additional insureds, as required pursuant to a written contract with a named insured, per attached 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 WRITTEN CONTRACT WITH THE NAMED INSURED. UMBRELLA/EXCESS LIABILITY The Umbrella/Excess Liability Limit that applies is the amount indicated on the face of this Certificate of Liability Insurance, or the minimum Umbrella/Excess Liability limit that is required by the written contract, whichever is less. However, if the primary insurance policies noted on the face of this Certificate of Liability Insurance satisfy the combination of minimum primary limits and minimum Umbrella/Excess Liability limits required by the written contract, the Umbrella/Excess Liability limits shown on the face of this Certificate of Liability Insurance do not apply. ACORD 101 (2008/01) © 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 - COMPLETED OPERATIONS - ENDORSEMENT A2A Named Insured Endorsement Number Johnson Centrals, Inc- MWZY Effective Date of Fndorsernent Policy Prefix Policy Number Policy Period 30544? - 14!01!2015 to 10I0i(2018 Issued By Old Republic Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided udder 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 listed on the certifica?e of insurance as additional insured, and each other person or organization required to be included as an additional insured pursuant to a contract with a named insured. Location And Description Of Completed Operations: As required by contract. 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 "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 "products-completed operations hazard". GL 289 002 1012 MKZY 305447 Johnson Controls, Inc. 10/01/2015 - 1010112016 Marsh USA Inc. MARSH I1001 Lakeline Blvd., Building 1, SuAe 260 Austin, TX 78717 Fax: 21 2 948 51 67 JCI.Certrequest o marsh.com September 2015 Subject: Johnson Controls, Inc. Certificate of Insurance Coverage Period: October 1, 2015 - October 1, 2016 Dear Valued Johnson Controls Customer: Enclosed is your Certificate of Liability Insurance for Johnson Controls. If provided to us, the project name and your company's contract number or purchase order number are referenced on the front of the certificate in the Description section. The Additional Remarks Schedule page has important information about the insurance coverages. Also attached to the certificate is the complete additional insured endorsement from the General Liability policy. If you have any questions or require additional Iiifurliiation, email or fax your inquiries to the address or number indicated above. IMPORTANT This is a system generated certificate. If you receive multiple certificates, disregard any that you do not need. If your firm does not require a certificate of insurance, please DISREGARD this letter and certificate of insurance. MARSH & MCLENNAN SOLUTIONS DE INED, DESIGNED, AND DELIVERED. gp COMPANIES