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HomeMy WebLinkAbout280216 JOHNSON CONTROLS INC - INSURANCE CERTIFICATE (8)a DATE (MM/DD/YYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE 1110312016 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 Marsh USA Inc. NAME:AX 411 E. Wisconsin Avenue PHONE 1 FqC, No): Suite 1300 E-MAIL ADDRESS: Milwaukee, WI 53202 - Attn: JCLCerVegUest@marSh.COm - INSURERS AFFORDING COVERAGE NAIC # 011077-Month-5-16-17 16Nov 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 1. INSURER C : 5757 North Green Bay Avenue INSURER D : Milwaukee, WI 53209 - INSURER E : /�r1\IC�An Cc f`CDTICIf•ATC kit IRA01=10- (.H I-00RAA01 fi3-01 RFVICIf1N NI IMRFR•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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY MWZY308341 10/01/2016 1010112017 EACH OCCURRENCE $ 10,000,000 - X� �-J J CLAIMS -MADE LOCCUR PREESOEa oc cur ence M S $ 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 PRODUCTS - COMP/OP AGG $ INC IN GEN AGG NPOLICY PRO ❑LOC JECT $ OTHER A AUTOMOBILE LIABILITY MWTB 308344 (Excludes NH) 10/01/2016 1010112017 COMBINED SINGLE LIMIT Ea accident $ 7,500,000 BODILY INJURY (Per person) $ A X ANY AUTO MWTB 308371 (NH) 10/01/2016 10/01/2017 BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS X X NON -OWNED HIRED AUTOS AUTOS PROPERTY TntDAMAGE $ New Hampshire (CSL) $ 250,000 B X UMBRELLA LiAB X OCCUR G28162509 001 10/01/2016 10/01/2017 EACH OCCURRENCE $ 5,000,000 X AGGREGATE $ 5,000,000 A EXCESS LIAB CLAIMS -MADE MWZX 308372 (NH) 10/01/2016 10101/2017 DED I I RETENTION $ New Hampshire (CSL) $ 7,250,000 A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A MWC 308342 00 (AOS - see page 2) MWXS 308343 (OH & WA) 10/01/2016 10/01/2016 10/01/2017 10/01/2017 X STATUTE OTERH E.L. EACH ACCIDENT $ 5,000,000 E.L. DISEASE - EA EMPLOYEE $ 5,000,000 E.L. DISEASE - POLICY LIMIT $ 5,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) JCI Project Number: 7N490008, JCI Project Name: COF EPIC Chiller Replacement, Customer PO Number: 9166777, CITY OF FORT COLLINS is included as additional insured per the attached endorsements A2 and A2A. CERTIFICATE 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 MukherjeenaA4_c.t-- U 19BU-2014 AGUKU GUKPUKA I IUN. All rlgnts reserves. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 011077 LOC #: Milwaukee AC40R ADDITIONAL REMARKS SCHEDULE v NAMED INSURED AGENCY Johnson Controls, Inc. Marsh USA Inc. Tyco International Holding S.a.r.l. 5757 North Green Bay Avenue POLICY NUMBER Milwaukee, WI 53209 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMAKKS 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, SO, 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, f 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 AM: 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. UMBRELLAIEXCESS 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 UmbrellalExcess 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 thereof, 30 days advice of cancellation will be delivered to certificate holders in accordance with the policy endorsements. Page 2 of 2 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD