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HomeMy WebLinkAboutTyco Simplex Grinnell; 2018-03-22; PWL18-99GSPWL18-99GS CITY OF CARLSBAD PUBLIC WORKS LETTER OF AGREEMENT ~OLE LIBRARY EMERGENCY FIRE PANEL REPAIR This RATIFICATION OF LETTER OF AGREEMENT between Tyco Simplex Grinnell, a Qelaware corpo@!ion, (Contractor) and the City of Carlsbad (City) is entered into as of the ~Nl., day of ·:::::::l.l)/iJLc./4 «< , 2018, but effective as of the 11th day of November, 2017, ratifying the work performed for the Cole Library Emergency Fire Panel Repair. The Contractor provided all equipment, material and-i-abor necessary to per Exhibit "A" and City specifications, for a sum not to exceed two thousand seven hundred fourteen dollars seventy-eight cents ($2,714.78). This work was completed within thirty (30) working days after the Notice to Proceed was issued. Upon full execution, the Letter of Agreement is ratified. ADDITIONAL REQUIRc'IVIENTS 1. City of Carlsbad Business License 2. The Contractor shall assume the defense of, pay all expenses of defense, and indemnify and hold harmless the City, and its agents, officers, officials, employees and volunteers, from all claims, loss, damage, injury and l1ability of every kind, nature and description, directly or indirectly arising from or in connection with the performance of this Contract or work; or from any failure or alleged failure of the contractor to comply with any applicable law, rules or regulations including those relating to safety and health; except for loss or damage which was caused solely by the active negligence of the City; and from any and all claims, loss, damage, injury and liability, howsoever the same may be caused, resulting directly or il"ldirectly from the nature of the work covered by this Contract, unless the loss or damage was caused solely by the active negligence of the City. The expenses of defense include all costs and expenses, including attorney's fees for litigation, arbitration, or other dispute resolution method. 3. Contractor shall furnish policies of general liability insurance, automobile liability insurance and a combined policy of workers compensation and Employers' Liability in an insurable amount of not less than one million dollars ($1,000,000) each, unless a lower amount is approved by the Risk Manager or the City Manager. Said policies shall name the City of Carlsbad as an additional insured. The full limits available to the named insured shall also be available and applicable to the City as an additional insured. Insurance is to be placed with California admitted insurers that have a current Best's Key Rating of not less tt.-.an "A-:VII"; OR with a surplus line insurer on the State of California's List of Approved Surplus Line Insurers (LASLI) with a rating in the latest Best's Key Rating Guide of at least "A:X"; OR an alien non-admitted insurer listed by the National Association of Insurance Commissioners (NAIC) latest quarterly listings report. Proof of all such insurance shall be given by filing certificates of insurance with contracting department prior to the signing of the contract by the City. 4. The Contractor shall be aware of and comply with all Federal, State, County and City Statues, Ordinances and Regulations, including Workers Compensation laws (Division 4, California Labor Code) and the "Immigration Reform and Control Act of 1986" (8USC, Sections 1101 through 1525), to include but not limited to, verifying the eligibility for employment of all agents, employees, subcontractors and ~nsultants that are included in this Contract. 5. The Contractor may be subject to civil penalties for the filing of false claims as set forth in the California False Claims Act, Government Code sections 12650, et seq., and Carlsbad Municipal Code Sections 3.32.025, etseg. .:p-c--init ____ init 6. The Contractor hereby acknowledges that debarment by another jurisdiction is grounds for the City of Carlsbad to disqualify the Contractor from participating in contract bidding. :?6:: init ___ init Cole Library Emergency Fire Parl!!J Repair --1 --City Attorney Approved 2/29/2016 PWL 18-99GS -7. The Contractor agrees and hereby stipulates that the proper venue and jurisdiction for resolution of any disputes between the parties arising out of this agreement is San Diego County, California. 8. The general prevailing rate of wages, for each craft or type of worker needed to execute the contract, shall be those as determined by the Director of Industrial Relations pursuant to the Section 1770, 1773 and 1773.1 of the California Labor Code. Pursuant to Section 1773.2 of the California Labor code, a current copy of applicable wage rates is on file in the office of the City Engineer. Contractor shall not pay less than the said specified prevailing rates of wages to all workers employed by him or her in the execution of the work covered by this Letter of Agreement. Contractor and any subcontractors shall comply with Section 1776 of the California Labor Code, which generally requires keeping accurate payroll records, verifying and certifying payroll records, and making them available for inspection. Contractor shall require any subcontractors to comply with Section 1776. 9. City Contact: Brian Bacardi 760-434-2944 Contractor Contact: Ryan Tolentino 858-633-9092 CONTRACTOR TYCO SIMPLEX GRINNELL, a Delaware corporation 3568 Ruffin Rd. San Diego, CA 92123 P: 858-633-9092 - F: 858-633-9101 rtolentino@simplexgrinnell.com (sign here) -...:!9-::'.:P.~o.µ~___:t::::.....C..::::::.._-_-....!.~~~.,:::::::~,.__c,=--l--~~~'.!...:W-~ (print n~me/title) By: (sign here) (print name/title) CITY OF CARLSBAD, a municipal corporation of the State of California By: Elaine Luke blic Works Director as authorized by the City Manager Dated: (Proper notarial acknowledgment of execution by Contractor must be attached. Chairman, president or vic.;-president and secretary, assistant secretary, CFO or assistant treasurer must sign for corporations. Otherwise, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering the officer(s) signing to bind the corporation.) APPROVED AS TO FORM: CELIA A. BREWER, CitrAttorney BY~ Deputy City Attorney Cole Library Emergency Fire Panel Repair --2 --City Attorney Approved 2/29/2016 DELEGATION OF AUTHORITY CERTIFICATE Johnson fj Controls The undersigned, Vice President and President, Building Solutions, North America, pursuant to the authority vested in him by: (i) a Sub-Delegation of Authority from Johnson Controls, Inc., a Wisconsin corporation ("Johnson Controls"), dated June 6, 2017, (ii) an Incumbency Certificate and Delegation of Authority from the general partner of SimplexGrinnell LP, a Delaware limited partnership ("SimplexGrinnell"), dated June 8, 2017, and (iii) a Written Consent in Lieu of Special Meeting ofthe Management Board from Tyco Integrated Security LLC, a Delaware limited liability company ("TIS"), dated June 8, 2017, hereby authorizes: Ramon R. C. Tolentino Senior Manager, Service (the "Delegate") to perform, on behalf of each of Johnson Controls, SimplexGrinnell and TIS, the acts described below: To execute and deliver any and all contracts for the performance of work, sale of goods, and furnishing of services, and any other instruments in connection therewith and in the ordinary course of business and in accordance with the current Global Approval Authority Matrix. This authority does not extend to: a. further sub-delegation of the above acts absent necessary approvals in writing; b. the execution of surety, performance or bid bonds; c. the signing of any notes, contracts, or any other agreement to borrow money in the name of Johnson Controls, SimplexGrinnell, or TIS, or any form of guaranty for the payment or performance of obligations of any subsidiary, affiliate, or joint venture of Johnson Controls, SimplexGrinnell, or TIS; or d. the signing, on behalf of Johnson Controls, SimplexGrinnell, or TIS, of any deeds, abstracts, offers to purchase or any other instruments pertaining to the purchase or sale of real property. Any actions taken by such Delegate within the scope of acts authorized herein taken between the date of expiration of any prior delegation of authority and the date hereof are hereby ratified, confirmed and approved as the acts and deeds of Johnson Controls, SimplexGrinnell, or TIS. This authority shall remain in full force and effect through October 25, 2018. Signed at Milwaukee, Wisconsin, this 26th day of October, 2017. Johnson Controls, Inc., SimplexGrinnell LP, and Tyco Integrated Security LLC Rodney N. Rushing Vice President and President Building Solutions, North America ATTESTS: Matthew R.A. Heiman, Assistant Secretary Johnson Controls, Inc. Robert C. Maxie, Secretary SimplexGrinnell LP and Tyco futegrated Security LLC tqca SimplexGdnne/1 D-U-N-S 09-4738007 FED. ID 58-2608861 District # 480 3568 Ruffin Rd SAN DIEGO,CA 92123-1103 858-633-9100 Billing Questions, Contact •=fiil@4 8 0-0 0718 904 City Of Carlsbad 405 Oak Ave Bldg Maintenance CARLSBAD CA 92008-3009 INVOICE NO. 84348666 SERVICE REOUEST# 40442502 Service Requested By: Brian Baccardi Scope of work for service performed on your Radionics Fire Alarm System is not covered by your service agreement Description of work Service Call Tech arrived on site, replaced spio board. Reprogrammed the new board. System is normal. Test a pull station, monitoring received signals. Service is complete Thank you for your business! INVOICE DA TE 12-13-17 SERVICE REQ. CREATED 11-15-17 Exhibit "A" [~ _____ P_O_N_U_"MB_E_R _____ ] NATIONAL ACCOUNT NUMBER 8700 PAYMENT TERMS Due upon receipt i,ih•iii 480-00813487 City of Carlsbad-Cole Library 1250 Carlsbad Village Dr Cole Library CARLSBAD CA 92008-1949 Requestors Phone Number: 760-585-8076 Labor Material Other Invoice Amount Taxes Total Invoice Amount Payment Received Total Amount Due t> $409.50 $2,139.47 $0.00 $2,548.97 $165.81 $2,714.78 $0.00 $2,714.78 tqca REMITTANCE COPY TOTAL AMOUNT DUE Slmp/11xGrfnn11/I ?L~ASc :3;:; CFF A};D RETTJRll :'':IS PCR~ION WITH YO::~ F/\YMEJC -WRI:~ INVOICE: NC :r YCUR CHECK snL To City Of Carlsbad 480-00718904 sHIP To City of Carlsbad-Cole Library 480-00813487 REMIT TO 6 7 6 -SL-Service-M9 97 SimplexGrinnell Dept. CH 10320 Palatine IL $2,714.78 INVOICE NUMBER 8 4 3 4 8 6 6 6 INVOICE DATE 12 -13 -1 7 CUSTOMER P.O. 60055-0320 2000340328984348666 tqca SimplexGdnnell Billing Questions: SERVICE DATE OF REO # TASK# .-. .. : ... ,1 "' 40442502 58874396 22-NOV-17 40442502 58874396 23-NOV-17 40442502 58874396 ll-DEC-17 . 6 77 -SL-Service-M997 District # 480 3568 Ruffin Rd SAN DIEGO,CA 92123-1103 858-633-9100 INVOICE SERVICE DETAIL PRODUCT ITEMIZATION OF CHARGES Tn ALARM AND DETECTION OVERTIME LABOR HRDW OP OT TRUCK CHARGE TRUCK CHARGE 4010 SFIO CPU BD 742-267 INVOICE NO. 84348666 DATE OF INVOICE 12-13-17 UOM AMOUNT 3 HR $409.50 1 EA $0.00 1 EA $2,139.47 ACORD• CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) ~ 03/12/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Marsh USA Inc. r._~)?N,jo i=vt1· Ir~ Nol: 411 E. Wisconsin Avenue Suite 1300 E-MAIL Milwaukee, WI 53202 ADDRESS: Attn: JCI.Certrequest@marsh.com INSURER($) AFFORDING COVERAGE NAIC# CN101230596--5-17-18' 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.l. INSURERC: SimplexGrinnell LP INSURER D: (see attached Acord 101) 5757 North Green Bay Avenue INSURER E: Milwaukee, WI 53209 INSURER F: COVERAGES CERTIFICATE NUMBER: CHl-008905822-02 REVISION NUMBER: 4 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 1 POLICY EFF ,~~rli~\ LIMITS LTR TYPE OF INSURANCE ,.,c:n wvn POLICY NUMBER MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY MWZY 310897 10/01/2017 10/01/2018 EACH OCCURRENCE $ 10,000,000 -~ CLAIMS-MADE 0 OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 10,000,000 X Contractual Liability MED EXP (Any one person) $ 50,000 f---10,000,000 X XCU Included PERSONAL & ADV INJURY $ f--- GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 30,000,000 ~ DPRO-DLOC PRODUCTS -COMP/OP AGG $ INC IN GEN AGG POLICY JECT OTHER: $ A AUTOMOBILE LIABILITY MWTB310896 (Excludes New Hamp) 10/01/2017 10/01/2018 COMBINED SINGLE LIMIT $ 7,500,000 /Ea accident\ A X ANY AUTO MWTB310898 (Primary NH $250k) 10/01/2017 10/01/2018 BODILY INJURY (Per person) $ -OWNED -SCHEDULED MWTB310899 (Excess NH $725mm) 10/01/2017 10/01/2018 A BODILY INJURY (Per accident) $ -AUTOS ONLY -AUTOS HIRED NON-OWNED Excess NH Auto is Follow Form PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY /Per accident\ --to Primary NH Auto $ l:l X UMBRELLA LIAB MOCCUR G28162509 002 10/01/2017 10/01/2018 EACH OCCURRENCE $ 5,000,000 -X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 OED I I RETENTION $ $ A WORKERS COMPENSATION MWC 310893 00 (AOS-see page 2) lU/Ul/Lu 17 10/01/2018 X I ;ffTuTE I I OTH- AND EMPLOYERS' LIABILITY ER A YIN MWXS 310894 (OH & WA) 10/01/2017 10/01/2018 ANYPROPRIETOR/PARTNER/EXECUTIVE 0 E.L. EACH ACCIDENT $ 5,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $ 5,000,000 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) Project Name of: Fire Protection Sys Inspection & Main! Svcs Project Number of: PEM1031 The City of Carlsbad is 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 provisions. CERTIFICATE HOLDER CANCELLATION City of Carlsbad/CMWD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE P.O. Box 4668 -ECM #35050 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN New York, NY 10163-4668 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. I Manashi Mukherjee Jlolo.~ ..... ~ © 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: _C-=-Nc.:....:...10=-1:..::2:..::.3..:..05-=-9::..c6::...._ ___________ _ LOC #: Milwaukee ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED Marsh USA Inc. Johnson Controls, Inc. Tyco International Holding S.a.r.l. POLICY NUMBER SimplexGrinnell LP (see attached Acord 101) 5757 North Green Bay Avenue CARRIER I NAIC CODE Milwaukee, WI 53209 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 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, Ml, 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 certholder and any other person or organization, BUT ONLY 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: 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. ONGOING OPERATIONS AND COMPLETED OPERATIONS INSURANCE The General Liability Insurance includes insurance for ongoing operations and completed operations. 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. UMBRELLA/EXCESS 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 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. 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 cancellation will be delivered to certificate holders in accordance with the policy endorsements. NAMED INSURED: 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; Chemguard, Inc.; Connect 24 Wireless Communications Inc.; Digital Security Controls, Inc.; Eastern Sheet Metal, Inc.; Elpas, Inc.; Exacq Technologies, Inc.; FBN Transportation, Inc.; Grinnell LLC, Hart & Cooley Tnucking Company; Hart & Cooley, Inc.; Haz-Tank Fabricators, Inc.; IMECO LLC; Integrated Systems and Power, Inc.; Interstate Battery System International, Inc.; Johnson Controls (Suisse) SA; Johnson Controls Advanced Power Solutions, LLC; Johnson Controls Air Conditioning and Refrigeration, Inc.; Johnson Controls APS Production, Inc.; Johnson Controls Battery Group, Inc.; Johnson Controls Building Automation Systems, LLC; Johnson Controls Engineering, LLC; Johnson Controls Federal Systems, Inc.; Johnson Controls Federal SystemsNersar, LLC; Johnson Controls Fire Protection LP; Johnson Controls Foundation, Inc.; Johnson Controls Government Systems LLC; Johnson Controls Navy Systems, LLC; Johnson Controls Security Solutions LLC; Koch Filter Corporation; Master Protection LP d/b/a FireMaster; Qolsys, Inc.; Retail Expert, Inc.; Ruskin Company; Ruskin Rooftop Systems, Inc.; Ruskin Service Company; Selkirk Corporation; Senelco Iberia, Inc.; Sensormatic Asia/Pacific, Inc.; Sensormatic Electronics (Puerto Rico) LLC; Sensormatic Electronics, LLC; Sensormatic International, Inc.; ShopperTrak International Investment LLC; ShopperTrak RCT Corporation; Shu~ointAmerica, Inc.; Tyco Cares Foundation; Tyco Fire & Security LLC; Tyco Fire Products LP; Tyco Integrated Security LLC; Tyco International Management Company, LLC; Visonic Inc.; WillFire HC, LLC; York International (SA), Inc.; and York International Corporation Page 2 of 2 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -SCHEDULED PERSON OR ORGANIZATION -ENDORSEMENT A2 Named Insured Endorsement Number Johnson Controls Inc. Tvco International Holding S.a.r.L Policy Prefix I Policy Number I Policy Period Effective Date of Endorsement MWZY 310897 10/01/17 to 10/01/18 10/01/2017 Issued By Old Reoublic Insurance Comoanv 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(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 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 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 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. GL 289 001 1012 MW2Y310897 Johnson Controls, Inc. Tyco International Ho/ding 10/01/2017-10/01/2018 IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -COMPLETED OPERATIONS -ENDORSEMENT A2A Named Insured Endorsement Number Johnson Controls, Inc. Tvco International Holding S.a.r.l. Policy Prefix I Policy Number I 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 0021012 MW2Y310897 Johnson Controls, Inc. Tyco International Holding 10/01/2017-10/01/2018 VYORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 0403 06 (Ed.~) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 0 otherwise due on such remuneration. % of the Galifornia workers' compensation premium SCHEDULE PERSON OR ORGANIZATION ANY PERSON OR ORGANIZATION AGAINST WHOM YOU HAVE AGREED TO WAIVE YOUR RIGHT OF RECOVERY IN A CONTRACT PROVIDED SUCH CONTRACT WAS EXECUTED PRIOR TO THE DATE OF LOSS. JOB DESCRIPTION ON FILE WITH COMPANY Endorsement Effective 10-01-17 Policy No. MWC 310893 00 Insured JOHNSON CONTROLS , INC . Insurance Company OLD REPUBLIC INSURANCE COMPANY © 1998 by the Workers' Compensation Insurance Rating Bureau cl Callfornla. All rights remrved. From the WCIRB's Ca&fornia Workers' Compensation Insurance Forms Manual © 1999. Endorsement No. Premium $ INCL . ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDD/YYYY) \.. ............ / 02/01/2018 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 REPRE~ENTATIVE 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 '. CONTACT Marsh USA Inc. NAME: PHONE I rUc Nol: 411 E. Wisconsin Avenue IAIC .,_ c-"· Suite 1300 E-MAIL Milwaukee, WI 53202 ADDRESS: Attn: JCI.Certrequest@marsh.com INSURER!Sl AFFORDING COVERAGE NAIC# 011077-J&T-PL-18-19 INSURER A: Zurich American Insurance Company 16535 INSURED INSURERB: Johnson Controls, Inc. Tyco International Holding S.a.r.l. INSURERC: SimplexGrinnell LP INSURERD: (see attached Acord 101) 575Z North Green Bay Avenue INSURERE: Milwaukee, WI 53209 INSURERF: COVERAGES CERTIFICATE NUMBER· CHl-008896803-03 REVISION NUMBER· 2 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 ' TYPE OF INSURANCE AODL SUBR POLICY EFF ,~~rJ%~1 LIMITS LTR lm~n luft,n POLICY NUMBER !MMIDDIYYYYl COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ '--D CLAIMS-MADE D OCCUR P~~~U?E~~~ence1 '--$ I--•, MED EXP (Any one person) $ I--PERSONAL & ADV INJURY $ GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ Fl POUCY D mg, D LOC PRODUCTS -COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY fi:~~~d~~.r'NGLE LIMIT $ >--ANY AUTO BODILY INJURY (Per person) $ >--OWNED ~ SCHEDULED BODILY INJURY (Per accident) $ >--AUTOS ONLY I--AUTOS HIRED NON-OWNED rROPERTY DAMAGE $ '--AUTOS ONLY >--AUTOS ONLY Per accidenll $ I-- ur,iBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESSLIAB CLAIMS-MADE AGGREGATE $ OED I I RETENTION$ $ WORKERS COMPENSATION I ~f~TUTE I I OTH- AND EMPLOYERS' LIABILITY ER YIN ANYPROPRIETOR/PARTNER/EXECUTIVE 0 NIA E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NHI E.L. DISEASE -EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ A Professional Liability EOC0238122-01 02/01/2018 02/01/2019 Each Claim and Related Claim 1,000,000 Aggregate Limit 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) CERTIFICATE HOLDER City of Carlsbad/CMWD c/o EXIGIS Insurance Compliance Services P.O. Box 4668 -ECM #35050 New York, NY 10163-4668 I ACORD 25 (2016/03) CANCELLATION 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 -...M.o..'\.I\.DO,._.. ~ © 1988-2016 ACORD CORPORATION. All rights reserved._ The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: _0:...c1c..c1..c..07'--7 ______________ _ LOC #: Milwaukee ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED . Marsh USA Inc. Johnson Controls, Inc . Tyco International Holding S.a.r.l. POLICY NUMBER SimplexGrinnell LP ( see attached Acord 101) fi157 North Green Bay Avenue CARRIER I NAICCODE Milwaukee, WI 53209 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance All services including Technology Services, Construction Management Services and Design/Build Services, Fire & Security products and services performed by the Building Technologies & Solutions units of Johnson Controls International pie. or on behalf of Building Technologies & Solufons Units of Johnson Controls International pie. by others acting under theii direction or trade name, including any such services that are performed electronically utilizing the Internet or a network of two or mare computers. Insureds include: Air Distribution Technologies IP1 LLC; Air System Components, Inc.; Carter Brothers, LLC; CEM Access Systems, Inc.; Central CPVC Corporation; Central Sprinkler LLC; Chagrin H.Q. Venture Ltd; Chemguard, Inc.; Connect 24 Wireless Communications Inc.; Digital Security Controls, Inc.; Eastern Sheet Metal, Inc.; Elpas, Inc.; Exacq Technologies, Inc.; FBN Transportation, Inc.; Grinnell LLC, Hart & Cooley Trucking Company; Hart & Cooley, Inc.; Haz-Tank Fabricators, Inc.; IMECO LLC; Integrated Systems and Power, Inc.; Interstate Battery System International, Inc.; Johnson Controls (Suisse) SA; Johnson Controls Advanced Power Solutions, LLC; Johnson Controls Air Conditioning and Refrigeration, Inc.; Johnson Controls APS Production, Inc.; Johnson Controls Battery Group, Inc.; Johnson Controls Building Automation Systems, LLC; Johnson Controls Engineeri~g. LLC; Johnson Controls Federal System~. Inc.; Johnson Controls Federal SystemsNersar, LLC; Johnson Controls Fire Protection LP; Johnson Controls Foundation, Inc.; Johnson Controls Government Systems LLC; Johnson Controls Navy Systems, LLC; Johnson Controls Security Solutions LLC; Koch Filter Corporation; Master Protection LP dlb/a FireMaster, Qolsys, Inc.; Retail Expert, Inc.; Ruskin Company; Ruskin Rooftop Systems, Inc.; Ruskin Service Company; Selkirk Corporation; Senelco Iberia, Inc.; Sensormatic Asia/Pacific, Inc.; Sensormatic Electronics (Puerto Rico) LLC; Sensormatic Electronics, LLC; Sensormatic International, Inc.; ShopperTrak International Investment LLC; ShopperTrak RCT Corporation; Shuooint America, Inc.; Tyco Cares Foundation; Tyco Fire & Security LLC; Tyco Fire Producls LP; Tyco Integrated Security LLC; Tyco International Management Company, LLC; Visonic Inc.; WillFire HC, LLC; York International {SA), Inc.; and York International Corporation The Professional Liability insurance referenced herein was placed by Aon Risk Services Central, Inc., or one or more of its subsidiaries or affiliates. Marsh is evidencing this coverage on this certificate for your convenience. Professional Liability coverage is clrums-made. Page 2 of 2 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD