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HomeMy WebLinkAbout108937 JOHNSON CONTROLS; YORK INTERNATIONAL - INSURANCE CERTIFICATEACOROII CERTIFICATE OF LIABILITY INSURANCE �- DATE (MMIDDYYYY7 OSI01/2012 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($). PRODUCER Marsh USA Inc. 411 E. Wisconsin Avenue CONTACT NAME: FAX PHONE Ext INC, No): E-MAIL ADDRESS: Suite 1600 Mlwaukee, WI 53202 Attn: JCI.Certrequest@marsh.00m 01 1077-MONTH-10-1 1 12APR INSURER $ AFFORDING COVERAGE NAIC a INSURER A: ACE American Insurance Company 22667 INSURED ' b ?� 1� Johnson Controls, Inc. U -/ York International Corporation INSURER e : SentryInsurance A Mutual Co 24988 INSURER C : Indemnity Insurance Company Of North America 43575 INSURER D :ACE Property And Casualty Ins Co 20699 AM: Cap. Risk Mgmt. X-92 P.O. Box 591 Milwaukee, WI 53201 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: CHI-004423109-01 REVISION NUMBER:0 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 TR OF INSURANCE ADOLTYPE INSR SU e POLICY NUMBER POLICY EFF IMMIDDIYYYYI POLICY EXP (MM/DDIYYYY)LIMITS A GENERAL LIABILITY HDOG25531693 1010112011 10/01/2012 EACH OCCURRENCE $ 5.000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE M OCCUR PREMISES Ea occur"'._- $ 5,000,000 MED EXP (Any we person) $ 50,000 PERSONAL B ADV INJURY It 5,000,000 X Contractual Liability X XCU Included GENERAL AGGREGATE $ 5,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 5,000,000 X1 POLICY PHI LOC $ B AUTOMOEILE LIABILITY 90-04606-01 10/0112011 1010112012 COMBINED SINGLE LIMIT Ea ai Cidem 5.000,000 X BODILY INJURY (Per person) $ B ANY AUTO 90-04606-02(MA) 10101/2011 10/0112012 ALL OVMED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per acclde,1 $ X NON -OWNED HIRED AUTOS AUTOS D X UMBRELLA LIAR X OCCUR XOOG25833284 1010112011 10101/2012 EACH OCCURRENCE $ 5,000,000 X EXCESS LIAB CLAIMS -MADE AGGREGATE $ 5,000,000 DED I I RETENTION$ $ C WORKERS COMPENSATION WLRG46770742 (ADS - See page 2) 10/01/2011 10101 012 X WG STAru- OTH- I A A AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE YIN O anclat ry in NER E%CLUDED9 N (Mandatory in NH) NIA WLRC46483704 (CA,AZ,MA) SCFG46770729 (W) 10/0112011 10/0112011 10/0112012 10101/2012 E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 A if yes, descdbe under DESCRIPTION OF OPERATIONS below WGUC46772374 (Excess WC - OH, WA) 1010112011 10101/2012 EL. DISEASE -POLICY LIMIT 1,000,000 $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is requlredl JCI Project Number: 24090109, JCI Project Name: City of Fort Collins Customer Training, Customer PO Number. Credit Card Payment, CITY OF FORT COLLINS and CITY OF FORT COLLINS are included as additional insured if required by Contract per the attached. ua:vJ�•J a:1 CITY OF FORT COLLINS 4316 W LAPORTE AVE FORT COLLINS, 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 ,vt_p, of reTKU e1 or S6i I fail d �iTllRAiS'�-TFx7S�S.1 ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 011077 LOC #: Milwaukee AGENCY Marsh USA Inc. POLICY NUMBER CARRIER ADDITIONAL REMARKS SCHEDULE Page 2 of 3 NAIC CODE NAMEDINSURED Johnson Controls, Inc. York International Corporation Attn: Corp. R sk Mgmt. X-92 P.O. Box 591 MiNvaukee, Wl 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 slates: AK, AL, AR, 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 lease or contract. 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 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 Conbact. 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 Cedlficate 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 Person(s) or Orgaripauon(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. POLICY ENDORSEMENT A2 ADDITIONAL INSURED - OWNERS, LESSEES OR CON1 RACTORS - NAMED INSURED '5 ACTS OR OMISSIONS ONLY 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 ongaing operations for the additional insured(s) at the ocallon(s) desgnaled 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' occumng after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than senice, 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. 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 arganizallon(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'productscompleled operations hazard'. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved I ne AI:UKU name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 011077 LOC #: Milwaukee A� ® ADDITIONAL REMARKS SCHEDULE Page 3 of 3 AGENCY NAMEDINSURED Marsh USA Inc. Johnson Controls, Inc. York International Corporation Atln: Corp. Risk Mgmt. X-92 POLICY NUMBER P.O. Box 591 MiNraukee, WI 53201 CARRIER NAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: zD FORM TITLE: ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD TION- All rights reserved