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HomeMy WebLinkAbout280216 JOHNSON CONTROLS INC - INSURANCE CERTIFICATE�`� " CERTIFICATE OF LIABILITY INSURANCE OATE(MMIDDYYYY) 031011)012 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 Marsh USA Inc. 411 E. Wisconsin Avenue CONTACT NAME: PHOE FAX -(AICNNE.11 INC, No): E-MAIL ADDRESS: Suite 1600 Milwaukee, WI 53202 Attn: JCl.Cerlreguest@marSh.com INSURERS) AFFORDING COVERAGE NAIC# INSURER A: ACE American Insurance Company 22667 011077— MONTH -10-11 12FEB INSURED Johnson Controls, Inc. York International Corporation INSURER B : Sentry Insurance A Mutual Co 24988 wsuRERc : Indemnity Insurance Company 01 North America 43575 INSURER D: ACE Property And Casualty Ins Cc 20699 Attn: Corp. Risk Mgmt. X-92 PO Box 591 Milwaukee, WI 53201 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: CHI-004392958-01 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 I TYPE OF INSURANCE ADD lijaR MID POLICY NUMBER MMIOIDYYYY Y MM DD YYV LIMITS A GENERAL LIABILITY HDOG25531693 1010112011 1CM112012 EACH OCCURRENCE $ 5,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ S,000,OOO CLAIMS -MADE OCCUR MED EXP(Any one person) $ 50,000 PERSONAL B ADV INJURY $ 5,0(U,000 X Contractual Liability X XCU Included GENERAL AGGREGATE $ 5,000,000 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGO $ 5,000,000 T POLICY F7 PRO- F7 LOC $ 8 AUTOMOBILE LIABILITY 90-0460601 1010112011 10/0112012 COMBINEDSINGLE LIMIT accident) $ 5,000,000 _jJEa BODILY INJURY (Perperson) $ B ANY AUTO 90-04606 02 (MA) 1010112011 1010112012 JX ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ DAMAGE Peraecidenh $ X NONOWNEDPROPERTY HIRED AUTOS AUTOS D X UMBRELLA LIAB X OCCUR XOOG25833284 1010112011 1010112012 EACH OCCURRENCE $ 5,000,000 X EXCESS LIAB CLAIMS -MADE AGGREGATE $ 5,000,000 DEC RETENTION$ $ I C A A WORKERS COMPENSATION EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICERIMEMBER EXCLUDED9 N (Mandatory in NH) NIA WLRC46770742 (AOS) WLRC46483704(CA,AZ,MA) SCFC46770729 (WI) 1010112011 1010112011 1010112DIl 1010112012 1010112012 10ID112012 X I WC STATU- DER TQRY LIMIT ER EL EACH ACCIDENT 1,000,000 $ EL.DISEASE - EA EMPLOYEE .$ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AHach ACORD 101, Additional Remarks Schedule, if more space is required) CI Project Number. 24090089, JCI Project Name: Discovery Sciences Museum TV Connection, Customer PO Number. 9120012, CITY OF FORT COLLINS and CITY OF FORT COLLINS are included as additional insured if required by contract per the attached. CITY OF FORT COLLINS 4316 W LAPORTE AVE FORT COLONS, CO 80521 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee �K0.'Vtl?04.: .�l++te•.e�-u� V 1BSti-2010 AGORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 011077 LOC #: Milwaukee ACCOR " ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh USA Inc. Johnson Controls, Inc. York International Corporation Attn: Corp. Risk Mgmt. X-92 POLICY NUMBER PO Box 591 Milwaukee, Wl 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 PRIMARY COVERAGE The Generat Liability and Automobile Liability policies are primary and not excess of or contributing won other insurance or set insurance, where required by lease or contract. WAIVER OF SUBROGATION The General Liability, Automobile Liability, Workers Compensation and Employers Liability policies include a waiver of subrogation in favor 6 the certificate holder to the extent required by contract. ADDITIONAL INSURED - AUTOMOBILE LIABILITY The Automobile Liability policy, if required by contract, includes coverage for Additional Insureds as required by contract. ADDITIONAL INSURED - GENERAL LIABILITY For General Liability, if required by contract, the following are included as additional insureds, as required pursuant to a contract with a named insured, per Policy Endorsements A2 and A2A, replicated below. The Certificate Holder LISTED ON THE FIRST PAGE OF THIS CERTIFICATE OF LIABILITY INSURANCE, and each other person or organization required to be included as an additional insured pursuant to a contract with the named insured. SCHEDULE FOR POLICY ENDORSEMENTS A2 AND A2A Name of Additional Insured Personls) or Organization(s): If required by contract, the person or organization listed on the cemucate of insurance as additional insured, and each other person or Organization required to be included as an additional insured pursuant to a comract with a named insured. Locauon(s) of Covered Operators: ' As required by contract. POLICY ENDORSEMENT A2 ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - NAMED INSUREDS ACTS OR OMISSIONS ONLY A, Section II - Who Is An Insured is amended to include as an additional insured the persona) 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(e) at the localion(s) designated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply, The 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 send hired by or on behalf of the additional insorerl 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 pan of the same deject. POLICY ENDORSEMENT A2A ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS - NAMED INSUREDS ACTS OR OMISSIONS ONLY Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organizations) 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 endorsemert performed for trial additional insured and included in the 'products completed operations hazard'. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD