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HomeMy WebLinkAboutInsurance Certificate: Johnson Controls DATE (MM/DD/YYYY) A41C"R" CERTIFICATE OF LIABILITY INSURANCE 09/22/2016 ~W~~. 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 NAME: Marsh USA Inc. FAX PHONE 411 E. Wisconsin Avenue A/c No. Ext : A/C No): Suite 1300 E-MAIL Milwaukee, WI 53202 ADDRESS: Attn: JCI.Certrequest@marsh.com INSURER(S) AFFORDING COVERAGE NAIC # 011077--5-16-17" 12-13 INSURER A : Old Republic Insurance Company 24147 INSURED INSURER B : ACE Property and Casualty Insurance Company 20699 Johnson Controls, Inc. Tyco International Holding S.a.r.l. INSURER c : 5757 North Green Bay Avenue INSURER D : Milwaukee, WI 53209 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: CHI-005658055-06 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. INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD _MD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY MWZY308341 10/01/2016 10/01/2017 EACH OCCURRENCE $ 10,000,000 DAMAGE TO RENTED 10,000,000 CLAIMS MADE OCCUR PREMISES Ea occurrence $ MED EXP (Any one person) $ 50,000 X Contractual Liability _ PERSONAL & ADV INJURY $ 10,000,000 X XCU Included GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 30,000,000 X POLICY " PRO JECT D LOC PRODUCTS - COMP/OP AGG $ INC IN GEN AGG OTHER: A AUTOMOBILE LIABILITY MWTB 308344 (Excludes NH) 10/01/2016 10101/2017 COMBINED SiNGLF LIMIT Ea accident $ 7,500,000 A X ANY AUTO MWTB 308371 (NH) 10/01/2016 10/01/2017 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per accident New Hampshire (CSL) $ $250,000 B X UMBRELLA LIAB X_ OCCUR G28162509 001 10101/2016 10/01/2017 EACH OCCURRENCE $ 5,000,000 A X EXCESS LIAB CLAIMS-MADE MWZX 308372 (NH) 10101/2016 10/01/2017 AGGREGATE $ 5,000,000 DED RETENTION $ New Hampshire (CSL) $ 7,250,000 OTH- A WORKERS COMPENSATION MWC 308342 00 (AOS - see page 2) 10/01/2016 10/01/2017 X PER STATUTE ER AND EMPLOYERS' LIABILITY A Y / N MWXS 308343 (OH 8 WA) 10/0112016 1010112017 5,000,000 E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE a N/A OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 5,000,000 If yes, describe under 5,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Ashland, Oregon and its elected officals, officers and employees are included as additional insured per the attached. 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 97502 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manasho Mukherjee ,NA AAe.- -et- ©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. Tyco International Holding S.a.r.l. POLICY NUMBER 5757 North Green Bay Avenue Milwaukee, WI 53209 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 Compensation "AOS" Policy includes coverage for the following states: AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, 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, WI, & 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 any other person or organization 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. LIMIT OF LIABILITY: The Liability Limit that applies is the amount indicated on the face of this Certificate of Liability Insurance, or the minimum Liability limit that is required by the written contract, whichever is less. If there is no contract then the Liability Limit is limited to $1,000,000. LIMIT OF UMBRELLA/EXCESS LIABIITY: 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. NOTICE OF CANCELLATION TO CERTIFICATE HOLDERS: This endorsement modifies the notice of cancellation of insurance provided hereunder: Should any of the above described policies be cancelled, other than for non-payment, before the expiration date thereot, 30 days advice of cancellation will be delivered to certificate holders in accordance with the policy endorsements. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION - ENDORSEMENT A2 Named Insured Endorsement Number Johnson Controls, Inc., Tyco international Holding S,a.r.l. Policy Prefix Policy Number Policy Period Effective Date of Endorsement MWZY 308341 110101116 to 10101117 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 listed on the certificate 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 'ensured. Location(s) Of Covered Operations: As required by contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. 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""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 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 person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. GL 289 001 1012 MAI&,rrl,/fAA`f AA ILL--.~~-.n.--Lv...Ar ..JA I^A S.+ AA A'. AAA/1A /AAA7 IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS - ENDORSEMENT A2A Named Insured Endorsement Number Johnson Controls, inc., Tyco International Holding S.a.r.i. Policy Prefix Policy Number Policy Period Effective Date of Endorsement N1VVZ 308341 10;01116 to 1061117 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 listed on the certificate of insurance as additional insured, and each other person or organization required to be inciuded 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 289 092 1012 wn rnw HS ^A A' A^A^. 1^^A-7