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18-138.00 Johnson Controls: CH Fire Alarm Systems 13- 1 -) Johnson 0'4 Controls SERVICE SOLUTION Billing Customer: Customer: Spokane Valley City Hall Spokane Valley City Hall 10210 E SPRAGUE Date: 27-AUG-18 SPOKANE VALLEY,WA 99206 Proposal#:644310 Term:01-SEP-18 to 31-AUG-21 Service Location: Johnson Controls Fire Protection LP Spokane Valley City Hall Sales Representative: 10210 EAST SPRAGUE AVE. Angie Fredrick SPOKANE VALLEY,WA 99206 10010 East Knox Ave SPOKANE, WA 99206-4156 AFredrick@simplexgrinneli.com INVESTMENT SUMMARY (Excludes applicable Sales Tax . Service Solution Valid for 45 Days) SERVICE/PRODUCT DESCRIPTION FREQUENCY INVESTMENT Recurring Annual Investment FIRE ALARM BASIC SERVICE OFFER Annual $540.00 GAMEWELL PROG SYSTEM SPRINKLER BASIC SERVICE OFFER Annual $484.00 WET SPRINKLER SYSTEM SPRINKLER BASIC SERVICE OFFER Annual $180.00 DRY SPRINKLER SYSTEM SPRINKLER BASIC SERVICE OFFER Annual $195.00 BACKFLOW SYSTEM EXTINGUISHER BASIC TEST&INSPECT Annual $75.00 EXTINGUISHERS/PORTABLES SYSTEM Total Recurring Annual Investment: $1,474.00 JC0001 US.ENG(Rev.4/6/18) Page 1 of 9 ©2018 Johnson Controls. All rights reserved Johnson op4 Controls SERVICE SOLUTION SUMMARY OF SERVICES SPRINKLER BASIC SERVICE OFFER- BACKFLOW SYSTEM TEST AND INSPECTION: Inspections and diagnostic tests for the accessible fire sprinkler devices listed and currently connected to fire sprinkler system.Tests will be scheduled in advance. Labor discount if bundled with Fire Alarm Service Offer(10% with FA Basic), (20% with Advance, Precision, or Comprehensive). DOCUMENTATION: Accessible components and devices logged for: Test results Any discrepancies found noted Inspection documentation provided to Customer. NOTE: Certain additional services may be required by the Authority Having Jurisdiction. AHJ or internal organizational requirements may be more restrictive than state/provincial requirements. Building owners and managers should make themselves aware of applicable codes and references in order to ensure that contracted Services fulfill requirements. In addition to the forward flow test required, For employees that are certified in backflow preventers, a back flow test meeting the requirements of the local water purveyor is to be performed annually SPRINKLER BASIC SERVICE OFFER - DRY SPRINKLER SYSTEM TEST AND INSPECTION: Inspections and diagnostic tests for the accessible fire sprinkler devices listed and currently connected to fire sprinkler system.Tests will be scheduled in advance. Labor discount if bundled with Fire Alarm Service Offer(10% with FA Basic), (20% with Advance, Precision,or Comprehensive). DOCUMENTATION: Accessible components and devices logged for: Test results Any discrepancies found noted Inspection documentation provided to Customer. NOTE: Certain additional services may be required by the Authority Having Jurisdiction.AHJ or internal organizational requirements may be more restrictive than state/provincial requirements. Building owners and managers should make themselves aware of applicable codes and references in order to ensure that contracted Services fulfill requirements. FIRE ALARM BASIC SERVICE OFFER - GAMEWELL PROG SYSTEM TEST AND INSPECTION: Inspections and diagnostic tests for the accessible peripheral devices listed and currently connected to the facility fire alarm system.Tests will be scheduled in advance.System labor discount on parts and peripherals of 10%. Unless otherwise specified herein, batteries installed within wireless initiating and notification peripheral devices are not covered under this agreement. Replacement of such batteries will be at an additional cost. DOCUMENTATION: Accessible components and devices logged for: Location of each device tested, including system address or zone location Test results and applicable voltage readings any discrepancies found noted Inspection documentation provided to Customer's representative. NOTE: Certain additional services may be required by the Authority Having Jurisdiction.AHJ or internal organizational requirements may be more restrictive JC0001 US.ENG(Rev.4/6/18) Page 2 of 9 ©2018 Johnson Controls. All rights reserved 01'Johnson Controls SERVICE SOLUTION than state/provincial requirements. Building owners and managers should make themselves aware of applicable codes and references in order to ensure that contracted services are in compliance with these requirements. EXTINGUISHER TEST & INSPECT - EXTINGUISHERS/PORTABLES SYSTEM TEST AND INSPECTION OVERVIEW: Inspections and diagnostic tests for the accessible portable fire extinguishers listed. Labor discount if bundled with Fire Alarm Service Offer(10%with FA Basic), (20% with Advance, Precision, or Comprehensive). Any recharges, hydrostatic testing, service parts and labor will be performed at the time of inspection and billed in addition to this agreement. DOCUMENTATION: Any discrepancies found will be noted. Inspection documentation shall be provided to Customer. NOTE: Certain additional services may be required by the Authority Having Jurisdiction.AHJ or internal organizational requirements may be more restrictive than state/provincial requirements. Building owners and managers should make themselves aware of applicable codes and references in order to ensure that contracted Services fulfill requirements. SPRINKLER BASIC SERVICE OFFER -WET SPRINKLER SYSTEM TEST AND INSPECTION: Inspections and diagnostic tests for the accessible fire sprinkler devices listed and currently connected to fire sprinkler system.Tests will be scheduled in advance. Labor discount if bundled with Fire Alarm Service Offer(10% with FA Basic), (20% with Advance, Precision,or Comprehensive). DOCUMENTATION: Accessible components and devices logged for: Test results Any discrepancies found noted Inspection documentation provided to Customer. NOTE:Certain additional services may be required by the Authority Having Jurisdiction.AHJ or internal organizational requirements may be more restrictive than state/provincial requirements. Building owners and managers should make themselves aware of applicable codes and references in order to ensure that contracted Services fulfill requirements. Annual Wet pipe sprinkler test&inspect includes inspecting gauges, systems valves, components and signs; operating control valves; testing tamper and flow switches,and local alarms and signals; opening main drain to record static and residual pressures; inspecting the fire department connection; and doing a building walkthrough to visually inspect sprinklers, piping, fittings and hangers from the floor level. Each control valve is operated in its full range and lubricated annually. Drain test is conducted after opening JC0001 US.ENG(Rev.4/6/18) Page 3 of 9 ©2018 Johnson Controls. All rights reserved Johnson '4.44t0 Controls SERVICE SOLUTION SPECIAL PROVISIONS Basic Inspection Reporting Customer Portal (Basic) System labor discount on parts and peripherals of 20% System parts discount on parts and peripherals of 10% This service quote has been put together using the Washington State contract#03115.Terms and conditions can be found on the Department of Enterprise Services website. JC0001 US.ENG(Rev.4/6/18) Page 4 of 9 ©2018 Johnson Controls. All rights reserved Johnson 004 Controls SERVICE SOLUTION This Service Solution (the"Agreement") sets forth the Terms and Conditions for the provision of equipment and services to be provided by Johnson Controls Fire Protection LP("Company")to Spokane Valley City Hall and is effective 01-SEP-18 to 31-AUG-21 (the"Initial Term"). PAYMENT TERM:Annual In Advance PAYMENT AMOUNT: $1 A74.00 - Proposal#:644310 CUSTOMER ACCEPTANCE: In accepting this Agreement, Customer agrees to the Terms and Conditions on the following pages and any attachments or riders attached hereto that contain additional terms and conditions. It is understood that these terms and conditions shall prevail over any variation in terms and conditions on any purchase order or other document that Customer may issue. Any changes in the system requested by Customer after the execution of Agreement shall be paid for by Customer and such changes shall be authorized in writing. ATTENTION IS DIRECTED TO THE LIMITATION OF LIABILITY, WARRANTY, INDEMNITY AND OTHER CONDITIONS CONTAINED IN THIS AGREEMENT. Spokane Vail�y,City Hall Johnson Controls Fire Protection LP Signature: XL (� .(�^ Angie Fredrick (), , l in . „ '/ , Print Name: f/V..0tt//\ L0I tk11 Phone#: 509-221-5010 Title: r. II . L I' Fax#; 509-535-5623 Phone#: 5—7 21)-I lad License#: (If Applicable) Authorized Fax#: Signature: Email: ►n CCt,I Vi vi @.5fC u“2 Vl[ 1. Print Name: PO#: V6/2 y� itle: IIDate: C1 V Date: a—21- lq JC0001 US.ENG(Rev.4/6/18) Page 5 of 9 ©2018 Johnson Controls. All rights reserved ACORO® DATE(MM/DD/YYYY) `� CERTIFICATE OF LIABILITY INSURANCE 09/04/2018 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 Marsh USA Inc. NAME: PHONE FAX 411 E.Wisconsin Avenue iA/C,No,Ext): (A/C,No): Suite 1300 EMAIL Milwaukee,WI 53202 ADDRESS: Attn:JCI.Certrequest@marsh.com INSURER(S)AFFORDING COVERAGE NAIC N CN101230596-exp-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. INSURER C: SimplexGrinnell LP INSURER D: (see attached Acord 101) 5757 North Green Bay Avenue INSURER E: Milwaukee,WI 53209 INSURER F: COVERAGES CERTIFICATE NUMBER: CHI-009081789-01 REVISION NUMBER: 1 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY MWZY 310897 10/01/2017 10/01/2018 EACH OCCURRENCE $ 10,000,000 DAMAGE TO RENTED - CLAIMS-MADE X OCCUR PREMISES Ea occurrence) $ 10,000,000 X Contractual Liability MED EXP(Any one person) $ 50,000 X XCU Included _PERSONAL 8 ADV INJURY $ 10,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 30,000,000 PO- X POLICY JET LOC PRODUCTS-COMP/OP AGG $ INC IN GEN AGG OTHER: $ A AUTOMOBILE LIABILITY MWTB310896(Excludes New Hemp) 10/01/2017 10/01/2018 Ea COMacciBINdent)ED SINGLE LIMIT $ 7,500,000 ( A X ANY AUTO MWTB310898(Primary NH$250k) 10/01/2017 10/01/2018 BODILY INJURY(Per person) $ A AOWNED UTOS ONLY SCHEDULED MWTB310899(Excess NH$7.25mm) 10/01/2017 10/01/2018 BODILY INJURY(Per accident) $ AUTOS HIRED NON-OWNED 'Excess NH Auto is Follow Form' PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) - 'to Primary NH Auto' $ B X UMBRELLALIAB X OCCUR G28162509 002 10/01/2017 10/01/2018 EACH OCCURRENCE $ 5,000,000 X EXCESS LIAR CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION$ $ A WORKERS COMPENSATION MWC 310893 00(AOS-see page 2) 10/01/2017 10/01/2018 x PER OTH- AND EMPLOYERS'LIABILITY Y/N MWXS 310894(OH&WA) 10/01/2017 10/01/2018 STATUTE ER A ANYPROPRIETOR/PARTNER/EXECUTIVE 55,000,000OFFICER/MEMBEREXCLUDED? N NIA E.L.EACH ACCIDENT $ _ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 5,000,000 If yes,describe under 5,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:General Service and Inspections See attached Acord 101 for additional information including Additional Insured,Primary/Non-contributory,Waiver of Subrogation and Notice of Cancellation provisions. CERTIFICATE HOLDER CANCELLATION Spokane Valley City Hall SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10210 E Sprague Ave THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Spokane Valley,WA 99206 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee _1VC.au.aoLi J+ .w.a ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN101230596 LOC#: Milwaukee ® AORD ADDITIONAL REMARKS SCHEDULE Page 2 of 2 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 NAIC CODE Milwaukee,WI 53209 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM ISA 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,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 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 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 Engineering,LLC;Johnson Controls Federal Systems,Inc.;Johnson Controls Federal SystemsNersar,LLC;Johnson Controls Fire Protection LP;Johnson Controls Foundation, Inc.;Johnson Controls Govemment 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;Shurjoint America,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 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.,Tyco International Holding S.a.r.l. 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(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 MWZY 310897 Johnson Controls,Inc.Tyco International Holding 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.,Tyco International Holding S.a.r.l. 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 MWZY 310897 Johnson Controls,lnc.Tyco international Holding 10/01/2017-10/01/2018 A Sr DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 09/04/2018 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). CONTACT • PRODUCER Marsh USA Inc. NAME: PHOE FAX 411 E.Wisconsin Avenue WC.o.Ext): (A/C,No): Suite 1300 E-MAIL Milwaukee,WI 53202 ADDRESS: Attn:JCI.Certrequest@marsh.com INSURER(S)AFFORDING COVERAGE NAIC S CN101230596-5-18-19' INSURER A:Oct Republic Insurance Company 24147 INSURED INSURER B:ACE PropertyCasualty p y Johnson Controls,Inc. and Insurance Com an 20699 Tyco International Holding S.a.r.l. INSURER C: SimplexGrinnell LP (see attached Acord 101) INSURER D 5757 North Green Bay Avenue INSURER E: Milwaukee,WI 53209 INSURER F: COVERAGES CERTIFICATE NUMBER: CHI-009081789-02 REVISION NUMBER: 1 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTRINSD WVD POLICY NUMBER (MM/DD/YYYY) NM/DOM/TY) A X COMMERCIAL GENERAL LIABILITY MWZY 313947 10/01/2018 10/01/2019 EACH OCCURRENCE $ 10,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 10,000,000 X Contractual Liability MED EXP(Any one person) $ 50,000 X XCU Included PERSONAL&ADV INJURY $ 10,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: - GENERAL AGGREGATE $ 30,000,000 X POLICY JECOT- LOC PRODUCTS-COMP/OP AGG $ INC IN GEN AGG OTHER: $ A AUTOMOBILE LIABILITY MWTB 313946(Excludes New Hamp) 10/01/2018 10/01/2019 COMBINED SINGLE LIMIT $ 7,500,000 A (Ea accident) X ANY AUTO MWTB 313949(Primary NH$250k) 10/01/2018 10/01/2019 BODILY INJURY(Per person) $ A OWNED AUTOS ONLY SCHEDULED MWZX 313950(Excess NH$7.25mm) 10/01/2018 10/01/2019 BODILY INJURY(Per accident) $ AUTOS HIRED NON-OWNED Excess NH Auto is Follow Form PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ to Primary NH Auto $ B X UMBRELLA LIAB X OCCUR G28162509 003 10/01/2018 10/01/2019 5,000,000 EACH OCCURRENCE $ X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION$ $ A WORKERS COMPENSATION MWC 313943 00(AOS-see page 2) 10/01/2018 10/01/2019 X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER A ANVPROPRIETOR/PARTNER/EXECUTIVE Y/N MWXS 313944(OH&WA) 10/01/2018 10/01/2019 5,000,000 OFFICER/MEMBEREXCLUDED? n N/A E.L.EACH ACCIDENT $ (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) RE:General Service and Inspections See attached Acord 101 for additional information including Additional Insured,Primary/Non-contributory,Waiver of Subrogation and Notice of Cancellation provisions. CERTIFICATE HOLDER CANCELLATION Spokane Valley City Hall SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10210E Sprague Ave THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Spokane Valley,WA 99206 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee -.314-akuool„L ,ti ..y ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN101230596 _ LOC#: Milwaukee ACCORD® ADDITIONAL REMARKS SCHEDULE Page 2 of 2 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 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,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 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;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,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 f/k/a SimplexGrinnell LP;Johnson Controls Government Systems LLC;Johnson Controls Navy Systems,LLC;Johnson Controls Security Solutions LLC f/k/a Tyco Integrated Security,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;Seneico Iberia,Inc.;Sensormatic Asia/Pacific,Inc.;Sensormatic Electronics(Puerto Rico)LLC;Sensormatic Electronics,LLC;Sensormatic International,Inc.;ShopperTrak International Investment LLC;ShopperTrak RCT Corporation;Shurjoint America,Inc.;SimplexGrinnell LP;Tyco Fire&Security LLC;Tyco Fire Products LP;Tyco International Holding S.a.r.i.; Visonic Inc.;WillFire HC,LLC;York International(SA),Inc.;York International Corporation;BC Liquidation,Inc.;Grinnell Fire Protection Solutions LLC;JCW HVAC Supply Center, LLC;Lau Holdings,LLC;Tyco Integrated Security LLC;and Tyco International Management Company,LLC ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights 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 Insured Endorsement Number Policy Prefix Policy Number Policy Period Effective Date of Endorsement 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(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. GL2890011012 MWZY 313947 Johnson Controls,Inc.Tyco international Holding 10/01/2018-10/01/2019 IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -COMPLETED OPERATIONS - ENDORSEMENT A2A Named Insured Endorsement Number Policy Prefix Policy Number Policy Period Effective Date of Endorsement 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 MWZY 313947 Johnson Controls,Inc.Tyco International Holding 10/01/2018- 10/01/2019