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Home My WebLink About280216 JOHNSON CONTROLS INC - INSURANCE CERTIFICATE (3)AC" p V" 1`L•/ CERTIFICATE OF LIABILITY INSURANCE DATE(/2015 YYYY) 09101/2015 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: PHONE FAX N� No. Exq: _. (A/C, No): E-MAIL ADDRESS: Suite 1300 Milwaukee, WI 53202 Attn: JCI.Certrequest@marsh.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: Old Republic Insurance Company 24147 011077-Month-CAS-14-15 15Sep INSURED Johnson Controls, Inc. York International Corporation INSURER B : North American Elite Insurance Company 29700 INSURER C : Indemnity Insurance Company of North America 43575 INSURER D: ACE American Insurance Company 22667 Attm Corp. Risk Mgmt. X-92 P.O. Box 591 5757 N. Green Bay Ave. INSURER E: ACE Fire Underwriters Insurance Company 120702 INSURER F : Milwaukee, WI 53201 COVERAGES CERTIFICATE NUMBER: CHI-006399779-01 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. INSRPOLICY LTR TYPE OF INSURANCE iNgn WVD SUER POLICY NUMBER MMIDD YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY302769 10/01/2014 10/01/2015 EACH OCCURRENCE $ 10,0130,000 X CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 10,000,000 X MED EXP (Any one person) $ 50,000 Contractual Liability X XCU Included PERSONAL & ADV INJURY $ 10,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 30,000,000 L-1 PRO X POLICY JECT ❑ LOC PRODUCTS - COMP/OP AGG $ INC IN GEN AGG $ OTHER D AUTOMOBILE LIABILITY ISA H08828623 10/01/2014 10/01/2015 COMBINED SINGLE LIMIT Ea accident) $ 5,000,000 _ X BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ HIRED AUTOS X AUTOS NON -OWNED B X UMBRELLA LIAB X OCCUR UMB 20DO252 00 10/01/2014 10/01/2015 EACH OCCURRENCE $ 5,000,000 X AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ C D E WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? � (Mandatory in NH) NIA WLR C48018786 (AOS - See page 2) WLR C48018804 (CA, MA, AZ) SCF C48018828 WI ( ) 10/01/2014 10/01/2014 10/01/2014 10101/2015 10/01/2015 10/01/2015 X I PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 5,000,000 E L. DISEASE - EA EMPLOYEE $ 5,000,000 D If yes, describe under DESCRIPTION OF OPERATIONS below WCU C48018816 (Excess WC - OH, WA) 10/01/2014 10/01/2015 E L. DISEASE -POLICY LIMIT $ 5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) JCI Project Number: 5N490102, JCI Project Name: Ctrl - City of Fort Collins Park Shop, Customer PO Number: 9154887, CITY OF FORT COLLINS is included as additional insured per the attached endorsements A2 and A2A. CERTIFICATE HOLDER CANCELLATION 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+r:mR.�ci [c urge t @ 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 ACORO® AGENCY Marsh USA Inc POLICY NUMBER CARRIER A r11llTll^KI A I E3C11A A M1l�+ �/�I Ir—Ma II r- •.■. —. ■ vvl 1L✓VLLG rage L or L NAMED INSURED Johnson Controls, Inc. York International Corporation Attn: Corp. Risk Mgmt. X-92 P O. Box 591 5757 N. Green Bay Ave. NAIC CODE Milwaukee, WI 53201 EFFECTIVE DATE: 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, 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: T HE 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 UmbreIWExcess 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. ^"�'�� '�' ��'�'► (0 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD