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HomeMy WebLinkAboutInsurance Certificate: Johnson Controls, Inc ' l `I'' DATE(MM/DDNYYY) '4��K° CERTIFICATE OF LIABILITY INSURANCE 08/18/2017 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 have ADDITIONAL INSURED provisions or 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: 411 E.Wisconsin Avenue (A H/C No,Ext): I(A/C,No): Suite 1300 E-MAIL Milwaukee,WI 53202 ADDRESS: Attn:JCI.Certrequest @marsh.com INSURER(S)AFFORDING COVERAGE NAIC# 011077--5-17-18' 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: SimplexGrinnell LP (see attached Acord 101) INSURER D 5757 North Green Bay Avenue _INSURER E: Milwaukee,WI 53209 INSURER F: COVERAGES CERTIFICATE NUMBER: CHI-008126093-07 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS INSD WVD (MM/DD/YYYY) (MM/DDNYYY) A X COMMERCIAL GENERAL LIABILITY MWZY 310897 10/01/2017 10/01/2018 EACH OCCURRENCE $ 10,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED 10,000,000 PREMISES( SES(Ea occurrence) $ X Contractual Liability MED EXP(Any one person) $ 50,000 X XCU Included PERSONAL&ADV INJURY $ 10,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 30,000,000 X POLICY PRO JECT LOC PRODUCTS-COMP/OP AGG $ INC IN GEN A—G- 1 OTHER: $ A AUTOMOBILE LIABILITY MWTB 310896(Excludes New Hamp) 10/01/2017 10/01/2018 COMBINED SINGLE LIMIT $ 7,500,000 A (Ea accident) X ANY AUTO MWTB 310898(New Hampshire Only) 10/01/2017 10/01/2018 BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ _ AUTOS ONLY AUTOS ONLY (Per accident) New Hampshire(CSL) $ 250,000 B X UMBRELLA LIAB X OCCUR G28162509 002 10/01/2017 10/01/2018 5,000,000 — EACH OCCURRENCE _ $ A X EXCESS LIAR MWZX 310899(NH-Excess Auto Only) 10/01/2017 10/01/2018 CLAIMS-MADE y) AGGREGATE $ 5,000,000 DED RETENTION$ New Hampshire Excess $ 7,250,000 A WORKERS COMPENSATION MWC 310893 00(AOS-see page 2) 10/01/2017 10/01/2018 X PER OTH- A AND EMPLOYERS'LIABILITY Y/N MWXS 310894(OH&WA) 10/01/2017 10/01/2018 STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE ( ) 5,000,000 OFFICER/MEMBER EXCLUDED? © N/A E.L.EACH ACCIDENT $ (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. Manashi Mukherjee 1''C,a.,�.. 6,-. -,$dam _h./J.4-CA- I ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 011077 LOC#: Milwaukee /"", ACORO 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 SimplexGrinnell LP (see attached Acord 101) 5757 North Green Bay Avenue CARRIER NAIC CODE Milwaukee,WI 53209 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 employees from the following States WHILE WORKING IN ANY STATE: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. Note that if Monitoring services are provided,Waiver of Subrogation does not apply to General Liability. 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. UMBERLLAIEXCESS LIABILITY: 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: Should any of the above described policies be cancelled,other than for non-payment,before the expiration date thereof,30 days advice of cancellation will be delivered to certificate holders in accordance with the policy endorsements. NAMED INSURED: Insureds include:Air Distribution Technologies IP,LLC;Air System Components,Inc.;Carter Brothers,LLC;CEM Access Systems,Inc.;Central CPVC Corporation;Central Sprinkler LLC;Chagrin H.Q.Venture Ltd;Chagrin Highlands Inc.;Chagrin Highlands Ltd.;Chemguard,Inc.;Connect 24 Wireless Communications Inc.;Detcon,Inc.;Digital Security Controls,Inc.;Eastern Sheet Metal,Inc.;Elpas,Inc.;Exacq Technologies,Inc.;FBN Transportation,Inc.;Grinnell LLC,Hart&Cooley Trucking Company;Hart&Cooley,Inc.;Haz- Tank Fabricators,Inc.;IMECO LLC;Infrared Systems Group,LLC;Integrated Systems and Power,Inc.;Interstate Battery System International,Inc.;Johnson Controls(Suisse)SA; Johnson Controls Advanced Power Solutions,LLC;Johnson Controls Air Conditioning and Refrigeration,Inc.;Johnson Controls APS Production,Inc.;Johnson Controls Battery Group,Inc.;Johnson Controls Building Automation Systems,LLC;Johnson Controls Engineering,LLC;Johnson Controls Federal Systems,Inc.;Johnson Controls Federal SystemsNersar,LLC;Johnson Controls Fire Protection LP;Johnson Controls Foundation,Inc.;Johnson Controls Government Systems LLC;Johnson Controls Navy Systems,LLC; Johnson Controls Security Solutions LLC;Koch Filter Corporation;Master Protection LP d/b/a FireMaster;Qolsys,Inc.;Retail Expert,Inc.;Ruskin Company;Ruskin Rooftop Systems,Inc.;Ruskin Service Company;Scott Technologies,Inc.;Selkirk Corporation;Senelco Iberia,Inc.;Sensormatic Asia/Pacific,Inc.;Sensormatic Electronics(Puerto Rico) LLC;Sensormatic Electronics,LLC;Sensormatic International,Inc.;ShopperTrak International Investment LLC;ShopperTrak RCT Corporation;Shurjoint America,Inc.;STI Licensing Corporation;STI Properties,Inc.;STI Properties,Ltd;STI Risk Management Co.;Tyco Cares Foundation;Tyco Fire&Security LLC;Tyco Fire Products LP;Tyco Integrated Security LLC;Tyco International Management Company,LLC;Visonic Inc.;WillFire HC,LLC;York International(SA),Inc.;and York International Corporation 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 310897 10/01/17 to 10/01/18 10/01/2018 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 insured. 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. GL2890011012 MWZY 310897 Johnson Controls,lnc.Tyco international Holding 10/01/2017- 10/01/2018 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.l. Policy Prefix Policy Number Policy Period Effective Date of Endorsement MWZY 310897 10/01/17-to 10/01/18 10/01/2017 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 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 MWZY 310897 Johnson Controls,lnc.Tyco International Holding 10/01/2017- 10/01/2018