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HomeMy WebLinkAboutSimplex Grinnell - Insurance CertificateACOOR& CERTIFICATE OF LIABILITY INSURANCE DATE ) 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 Marsh USA Inc 411 E Wisconsin Avenue CONTACT NAME PHONE aC No Suite 1300 Milwaukee, WI 53202 E -MAIL ADDRESS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX1 OCCUR Attn JCI Certrequest@marsh com INSURERS AFFORDING COVERAGE NAIC # INSURER A Old Republic Insurance Company 24147 011077- 5- 17 -18' 2 INSURED Johnson Controls, Inc INSURER B ACE Property and Casualty Insurance Company 20699 INSURER C MED EXP (Any one person) Tyco International Holding S a r I SimplexGnnnell LP (see attached Acord 101) INSURER D 5757 North Green Bay Avenue INSURER E X Milwaukee, WI 53209 INSURER F $ 10,000,000 COVERAGES CERTIFICATE NUMBER: CHI - 008592814 -02 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF (MM/DD/YYYYI POLICY EXP IMMIDDrYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX1 OCCUR MWZY 310897 10/01/2017 10/01/2018 EACH OCCURRENCE $ 10,000,000 DAMAGE TO IINTI PREMISES Ea occurrence) $ 10,000,000 X MED EXP (Any one person) $ 50,000 Contractual Liability X XCU Included PERSONAL 8 ADV INJURY $ 10,000,000 GEN'L AGGREGATE LIMIT APPLIES PER X POLICY 1-1 JECOT- F7 LOC GENERAL AGGREGATE $ 30,000,000 PRODUCTS - COMPIOP AGG $ INC IN GEN AGG $ OTHER A A AUTOMOBILE LIABILITY ANY AUTO MWiB 310896 (Excludes New Hamp) MWTB 310898 (New Hampshire Only) 10/0112017 10/0112017 10/0112018 10/01/2018 COMBINED SINGLE LIMIT Ea accident $ 7,500,000 X BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ " New Hampshire (CSL) $ 250,000 A X UMBRELLALIAB EXCESS L1AB X OCCUR CLAIMS -MADE G28162509002 MWZX 310899 (NH - Excess Auto Only) 1010112017 10/01/2017 1010112018 10/01/2018 EACH OCCURRENCE $ 5,000,000 X AGGREGATE $ 5,000,000 DIED I I RETENTION $ New Hampshire Excess $ 7,250,000 A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICERIMEMBEREXCLUDED? ❑N N / A MWC 310893 00 (AOS - see page 2) MWXS 310894 (OH 8 WA) 10(0112017 10/01/2018 1010112018 X PER OTH- STATUTE ER E L EACH ACCIDENT $ 5,000,000 E L DISEASE - EA EMPLOYEE $ 5,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $ 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) The City, Its officers and employees Is /are Included as additional Insured per the attached See attached Acord 101 for additional Information Including Additional Insured, Primary/Non- contributory, Waiver of Subrogation and Notice of Cancellation provisl VCR 11x1%. 0%1 C liluLL111i C:ANC:tLLJA 1 IUN CITY OF GILROY 7351 ROSANNA STREET GILROY,, CA 95020 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. Manashl Mukherjee _MAUao►�+ ©1988 -2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ACO L AGENCY CUSTOMER ID: 011077_____ LOC #: Milwaukee_ ADDITIONAL REMARKS SCHEDULE Page 2 of _2 AGENCY NAMED INSURED Marsh USA Inc Johnson Controls, Inc Tyco International Holding S a ri 'SlmplexGnnnell LP - POLICY NUMBER (see attached Acord 10 1) 5757 North Green Bay Avenue Milwaukee „WI 53209 CARRIER NAIC CODE EFFECTIVE DATE: - ADDITIONAL THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM,TITLE: Certificate of Liability Insurance WORKERS COMPENSATION Workers Compensabon'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 re4ulred by written contract, includes coverage for Additional Insureds as required by such written contract ADDITIONALINSURED - GENERAL LIABILITY For General Liability, d 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 ADDITIONALINSURED PURSUANT TO A WRITTEN CONTRACT WITH THE NAMED INSURED LIMIT, OF LIABILITY The Liability Lund -that applies is the amount indicated on the face of this Certificate of Liability Insurance, or the minimum Liabilitydimit that is required by the written contract, 'whichever is less- If there is no contract then the Lability Limit is limited to $1,000,000 UMBERLLAlEXCESS LIABILITY If the primary insurance policies noted on the face of this Certificate of Liability Insurance satisfy the combination of minimum primary limits and minim_ um Umbrella/Excess Liability limits required bq the written contract, the'UmbrellafExcess Liabihtyllimits 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 eancellabon,wdl be delivered to certificate holders in accordance with the policy endorsements NAMEDINSURED 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 , Ezacq Technologies, Inc. FBN Trar sp nation, 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, ILLC, Johnson Controls Air Conditioning and Refrigeration, Inc , Johnson Controls APS'Production, iInd , Johnson Controls Battery Group, Inc , Johnson Controls Budding Automation Systems, LLC, Johnson Controls Engineering, LLC, Johnson Controls Federal Systems, Inc , Johnson Controls Federal SystemslVersar, LLC, Johnson Controls Fire Protection LP, Johnson Controls'Foundation,'Inc ; Johnson Controls Government Systems LLC, Johnson Controls Navy Systems, LLC, Johnson Controls Security SolutionsiLLC, Koch Filter Corporation, Master'Protection LP dlbla'FireMaster, Qolsys, Inc , Retail Expert, Inc , Ruskin Company, 'Ruskin Rooftop Systems, Inc, Ruskin Service Company, Scott Technologies, Inc , Selkirk Corporabon, Senelco Iberia, Inc , Sensormatic AsialPacific,'Inc , Sensormatic Electronics_ (Puerto Rico) LLC, Sensormatic Electronics, LLC, Sensormatic International, Inc, ShopperTrak International Investment LLC, ShopperTrak RCT Corporation, Shurfomt 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, iLLC, Visonic Inc , WdlFire'HC, LLC, York dnternational (SA), 'Inc , and York International Corporation 4CORD 101 (2008/( k `I 2008 ACORD CORPORATION. All rigt%ts ,reserved. The ACORD name and logo are,registered marks of ACORD - " IL-10 (12106) OLD REPUBLIC INSURANCE COMPANY ADDITIONAL INSURED = OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION - ENDORSEMENT A2 ,Named Insureds Endorsement Number - Johnson Controjs Iric T' co International Holds - S a Policy Prefix, Policy Number Policy Period Effective Date of Endorsement MWZY 11310897 10/01 / 17 to 10 /01 /,18_ 10/01/2018 Issued Old Rib ublic 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 Insi fired Person(s) Or Orgaiiizatiori(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 toltie included as.an additional insured pursuant to a contract with a namedlinsured 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 pis "An Insured is amended to include as an additional insured the persons) or organizations) shown- in 'the- but only with respect` to 'liability for "bodily' injury", " pro perty °,dam_ age "�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,br repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operatroris'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,principaI as a -part of the same project GC 289 001 '1012• ql ZI 310897 Johnson Controls, thaTyco lnternatlonal Holding 1010112017 - 1010112018 IL 10 (12106) OLD REPUBLIC INSURANCE COMPANY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS - ENDORSEMENT A2A Named Insured Endorsement Number Johnson Controls Inc , T co International Holdma S a r I 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 MkM 310897 Johnson Controls, Inc. Tyco International Holding 1010112017 - 1010112018 IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY 'PLEASE READ IT CAREFULLY WAIVER OF TRANSFER'OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following. BUSINESS AUTO COVERAGE_ FORM_ GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM - TRUCKERS COVERAGE FORM SCHEDULE Name of Pelson orOrganization: Any person or organization that you are required by contract to waive recovery right (If -no entry °appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement ) The Transfer Of'Rights Of Recovery Against Others To Us Condition is changed by addingthe following We- waive any right of recovery we may have against the person(s) or organization(s) shown in the Schedule because of,payments we make for'injury or damage This waiver applies�orily to the person or organization shown in the Schedule PCA,024 03 06 MKrrB 310896 Johnson Controls, 1ne.Tyco International Holding 10101/2017 - 1010112018