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A MEMORANDUM OF INSURANCE CAN BE ACCESSED AT http: / /www.marsh.com /inoi "client =0969 ICI Branen No -vii tiom
<br />rlg) INC.
<br />EF?TIF'FAT; o,iu�S�iRat�+'c
<br />12/08/2003
<br />PRODUCER
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
<br />NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE
<br />Marsh USA Inc. 965SE
<br />POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
<br />411 East Wisconsin Avenue
<br />AFFORDED BY THE POLICIES DESCRIBED HEREIN.
<br />Suite 1600
<br />AM Bail Rating
<br />Milwaukee, Wisconsin 53202 -4419
<br />Attn: CPU, Phone (414) 290 -4985 Fax (414) 2904953
<br />COMPANIES AFFORDING COVERAGE
<br />(b of 12AW03)
<br />*See Below
<br />Company Pacific Employers Insurance Company
<br />A 1601 Chestnut Street, PO Box 41484, Philadelphia, PA 19101
<br />A XII
<br />CPU_Milwaukee @marsh.com
<br />A -aoD� - �aa
<br />INSURED
<br />Johnson Controls, Inc. Attn: Corp. Risk Mgmt. X -92
<br />Johnson Controls Battery Group, Inc. P.O. Box 591
<br />Johnson Controls Interiors, L.L.C. Milwaukee, WI 53201
<br />Johnson Controls of Puerto Rico, Inc.
<br />Company Sentry Insurance A Mutual Co.
<br />B 1800 North Point Drive, Stevens Pant, WI 54481
<br />A+ XIV
<br />Company ACE American Insurance Company
<br />C PO Box 41484, Philadelphia. PA 19101
<br />A XII
<br />GES America, L.L.C.
<br />Optima Batteries, Inc.
<br />Company
<br />D
<br />... re'iai
<br />C£11t � ,'. :: ?Thscerbfi ais6 ...arta
<br />THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED.
<br />NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY
<br />PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND EXCLUSIONS OF SUCH POLICIES, LIMITS SHOWN
<br />MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />CO
<br />LT
<br />R
<br />TYPE OF INSURANCE
<br />POLICY NUMBER
<br />POLICY EFFECTIVE
<br />DATE (MM/DD/YY)
<br />POLICY EXPIRATION
<br />DATE (MWDDIYY)
<br />LIMITS
<br />A
<br />GENERAL
<br />LIABILITY (1) (2) (3)
<br />COMMERCIAL GENERAL LIABILITY
<br />HDOG2173195A
<br />10 -1 -2003
<br />10-1-2004
<br />GENERAL AGGREGATE
<br />$ 5,000,000
<br />X
<br />PRODUCTS - COMP /OP ASS
<br />$5,000,000
<br />CLAIMS MADE F OCCUR
<br />PERSONAL 8 ADV INJURY
<br />$ 5,000,000
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />OWNER'S 8 CONTRACTOR'S PROT
<br />X
<br />FIRE DAMAGE An one fire
<br />$5,000,000
<br />Contractual
<br />XD
<br />sexii D0/e31 acons nal Irlsamxl- Onnen,
<br />Lessees or CgnlmMa @IFDmI BI
<br />MED EXP (Any one erson
<br />$ 50,000
<br />B
<br />AUTOMOBILE
<br />X
<br />LIABILITY (1) (2) (3)
<br />ANYAUTO
<br />90- 04606 -01
<br />10 -1 -2003
<br />10- 1-2004
<br />COMBINED SINGLE LIMIT
<br />$ 2,000,000
<br />BODILY INJURY
<br />X
<br />ALL OWNED AUTOS
<br />X
<br />SCHEDULED AUTOS
<br />(Per person)
<br />X
<br />HIREDAUTOS
<br />BODILY INJURY
<br />x
<br />NON -OWNED AUTOS
<br />(Per accident)
<br />PROPERTY DAMAGE
<br />B
<br />X
<br />AUTO PHYSICAL DAMAGE (i)
<br />90- 04606 -07
<br />10 -1 -2003
<br />10 -1 -2004
<br />DEDUCTIBLES: Comprehensive: ACV less $1,000
<br />deductible /Collision: ACV less$1,000deductible.
<br />GARAGE LIABILITY
<br />AUTO ONLY -EA ACCIDENT
<br />OTHER THAN AUTO ONLY
<br />ANV AUTO
<br />EACH ACCIDENT
<br />AGGREGATE
<br />C
<br />MEXCESS LIABILITY
<br />UMBRELLA FORM
<br />XOOG20581803
<br />10 -1 -2003
<br />10- 1-2004
<br />EACH OCCURRENCE
<br />$5,000,000
<br />AGGREGATE
<br />$5,000,000
<br />OTHER THAN UMBRELLA FORM
<br />A
<br />WORKERS COMPENSATION AND
<br />WLRC43535572
<br />10 -1 -2003
<br />10 -1 -2004
<br />X
<br />WCSTATU-
<br />OTH
<br />EMPLOYERS' LIABILITY (3)
<br />TORY LIMITS
<br />ER
<br />"
<br />THE PROPRIETOR/ Jv INCL
<br />(_JI
<br />The Pacific Employers Insurance Company
<br />program applies to all JCI entities in all states
<br />except for the selHnsured entities and the
<br />monopolistic states.
<br />EL EACH ACCIDENT
<br />$ 1,000,000
<br />EL DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />EL DISEASE -EACH EMPLOYEE
<br />$ 1,000,000
<br />PARTNERS/EXECUTIVE EXCL
<br />OFFICERS ARE :
<br />OTHER
<br />(1)
<br />ADDITIONAL INSURED /LOSS PAYEE: Includes coverage for Additional Insureds 8 Loss Payees as required by lease or contract.
<br />If required by contract, this includes: NOTE: CG 20 10 10 93 is attached
<br />(2)
<br />(3)
<br />PRIMARY COVERAGE: Where required by lease or contract, this coverage is primay and not excess of or Contributing with other insurance or self - insurance. s /
<br />WAIVER OF SUBROGATION: Insured waives subrogation to the extent required by contract. Y
<br />DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES /SPECIAL ITEMS J01 Contract No,
<br />Project Name:
<br />Customer PO Number:
<br />CIER'"PICATE" Ggti:
<br />GAIN
<br />SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,
<br />City of Ana
<br />THE ISSUING COMPANY WILL GNGGAYpR3C MAIL 30 DAYS WRITTEN NOTICE TOTHE CERTIFICATE HOLDER
<br />NAMED HEREIN,
<br />.Santa
<br />Office O! l the City Attorney
<br />20 Civic Center Plaza
<br />PO Box 1988
<br />Santa Ana, CA 92702
<br />MARSH USA INC. BV:
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