CERTIFICATES OF INSURANCE 05-27-99 AND 05-27-00
PRODUCER I'}::: THIS CERTIFICATE IS ISSUE. lAS A MATTER OF INFORMATION ONLY AND CONFERS
J&H Marsh .& McLennan, I nc . NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN
777 South Figuer a Str t THE POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
Los Ange 7 es, CA 0900 17 =~822 COVERAGE AFFORDED BY THE POLICIES LISTED HEREIN.
COMPANIES AFFORDING COVERAGE
2137368489
COMPANY
A ZURICH AMERICAN INS. CO.
INSURED
Church of Sciento7ogy
503 Cleve7and Street
C7earwater, FL 34616
COMPANY
B
COMPANY
C
COMPANY
o
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED,
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY
BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES LISTED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND EXCLUSIONS
OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
CO
L TR TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MMJODNVI DATE IMM/DDNY)
A GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE [!]OCCUR
OWNER'S & CONTRACTOR'S PROT
GL0929 735 7 -OJ
5/27/99 5/27/00
LIMITS
GENERAL AGGREGATE $ 2,000,000
PRODUCTS - COMP/OP AGG $ 2,000,000
PERSONAL & ADV INJURY $ 1,000.000
EACH OCCURRENCE $ 1,000,000
FIRE DAMAGE IAnv one fire) $ 1,000,000
MED EXP IAnv one person} $ 10,000
COMBINED SINGLE LIMIT $
BODILY INJURY $
(Per personl
BODILY INJURY $
I Per accident)
PROPERTY DAMAGE $
AUTO ONLY. EA ACCIDENT $
OTHER THAN AUTO ONLY;
EACH ACCIDENT $
AGGREGATE $
EACH OCCURRENCE $
AGGREGATE
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
ANY AUTO
EXCESS LIABILITY
UMBRELLA FORM
'. frIHfB...TI:!AN UM.Eill];LLA-.f~_..
THE PROPRIETOR/
PARTNERS/EXECUTIVE
OFFICERS ARE:
OTHER
INCL
OTH-.~:.
ER :cc:c:::::::::::::.:.:::::.:.
$
..
. .. ...
...................
...................
WORKER'S COMPENSATION AND
EMPLOYERS' L1ABILlTV
EXCl
El DISEASE - POLICY LIMIT $
El DISEASE - EA EMPLOYEE
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / SPECIAL ITEMS
Re:Permit No.98-098 for erection of temporary chain Unk fence on b70ck
sorrounded by Ft. Harrison Ave., Pierce Street. Frank7in St. and Garden
A venue.
(See reverse and/or attached for additiona7 infonmation.)
]:;~61!tl.QA:T~mi.i!9.li;Pifr:: ::::::::::::::c:c::c::::c::::::::::::::::::::::::::::::::::::c:::::::::::: .. ...:..::......... .....
CITY OF CLEARWA TER
112 South Ocea 7 a A venue
C7earwater. FL 33758
jtCANCEiiiLAtION) :<':":::'::'::::...:: :::::i:::::::::::::::c:.:-::::::::c::::::::::.:.:.:.:.. ..
SHOULD ANY OF THE POLICIES LISTED HEREIN BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL
~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED HEREIN, BUT
FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE N OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER AFFORDING ERAGE, IT AGENTS' OR
REPRESENTATIVES, OR THE ISSUER OF THIS TIE ATE. f
J&H MARSH & MCLENNAN. INCORPORATED
BY:
PRODUCER
J&H Marsh & McLennan, Inc.
777 South Figueroa Street
Los Angeles, CA 90017-5822
THIS CERTIFICATE IS ISSlTED AS A MATTER OF INFORMATION ONLY AND CONFERS
NO RIGHTS lTPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN
THE POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
COVERAGE AFFORDED BY THE POLICIES LISTED HEREIN.
COMPANY
LETTER
COMPANIES AFFORDING COVERAGE
A AMERICAN GUAR & LIAB
INSURED
Church of Scientology
Flag Service Organization, Inc
551 North Saturn
Clearwater, FL 34615
COMPANY
LETTER
B
COMPANY
LETTER
C
COMPANY
LETTER
D
CO
LTR
IA GENERAL UABIUTY
f---
X COMMERCIAL GENERAL LIABILITY
I-- DCLAIMS MADE[i]OCCUR.
f---
OWNER'S CONTRACTOR'S PROTo
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY
BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES LISTED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND EXCLUSIONS
OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
POUCY EFFECTIVE
DATE (MM/DDfYVl
5/27/98
TYPE OF INSURANCE
POlICY NUMBER
POlICY EXPIRATION
DATE (MM/DD/YV)
5/27/99
UMITS
GL0929735700
GENERAL AGGREGATE $
PRODUCTS-COMP lOP AGG $
PERSONAL & ADV INJURY $
EACH OCCURRENCE $
FIRE DAMAGE (Anyone fire) $
MED. EXPENSE (Anyone person) $
2000000
2000000
I--
I--
1000000
1000000
1000000
10000
AUTOMOBILE UABILTY
-
-
-
.- -------
EXCESS LJABIUTY
I UMBREUA FORM
I OTHER THAN UMBREUA FORM
WORKERS' COMPENSATION AND
EMPLOYERS UABIUTY
-
COMBINED SINGLE LIMIT $
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
PROPERTY DAMAGE $
AUTO ONLY EA ACCIDENT $
OTHER THAN AUTO ONLY
EACH ACCIDENT $
'AGGREGATE- _.. ----$ -- , -'
EACH OCCURRENCE $
AGGREGATE $
STATUTORY LIMITS
EACH ACCIDENT $
DISEASE - POLICY LIMIT $
DISEASE EACH EMPLOYEE $
ANY AUTO
ALL OWNED AUTOS
-
SCHEDULED AUTOS
-
-
HIRED AUTOS
NON-OWNED AUTOS
-
1 -::\ fe Un ~ Q.W JL.... 'l\
~\ .lU~ 8 \998 _.1-
-- 1'NOFC~EAf\WA'ER --'
- Q -- .
-
GARAGE UABIUTY
-
-
-
-
ANY AUTO
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
Re: The monitor sensor that Flag Org. has attached to the fence they share
on the same side of the property as the nursery next to their property.
CERTIFICATE HOLDER
CANCELLATION
City of Clearwater
P.o. Box 4748
Clearwater, FL 34618-4748
SHOULD ANY OF THE POLICIES LISTED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE
THEREOF, THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CE?F...!.CATE HOLDER NAMED HEREIN, BUT FAILURE TO MAIL SUCH NOTICE
SHALL IMPOSE TION Qf LIABILITY OF ANY KIND UPON THE INSURER AFFORDING
COVERAGE, I~Er/'S OR R~SENTATIVES. OR THE ISSUER OF THIS CERTIFICATE.
J&H MARSH &
BY: a ""
--
"-
VAlID AS OF\: 6/01/98
MMll (8/9~
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