CERTIFICATE OF INSURANCE (2)
CERTIFICAT6:'.6:,F::ii::'il
PRODUCER
Marsh Risk & Insurance Services
License No. 0437153
777 South Figueroa Street
Los Angeles, CA 90017
CERTIFICATE NUMBER
THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE
POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
AFFORDED BY THE POLICIES DESCRIBED HEREIN.
COMPANIES AFFORDING COVERAGE
03665-GUAL--OO/O1
COMPANY
A Zurich-American Insurance Company
COMPANY
B
COSF
INSURED
CHURCH OF SCIENTOLOGY
DBA: FLAG SERVICE ORGANIZATION
503 CLEVELAND STREET
CLEARWATER, FL 34616
COMPANY
C
COMPANY
D
certificate supersedes and replaces any previously issued certificate. 0
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED 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 DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. CONDITIONS AND EXCLUSIONS OF SUCH POLICIES. LIMITS SHOWN
MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO
LTR
TYPE OF INSURANCE
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MM/DDIYY) DATE (MM/DD/YY)
OS!?? IOn
POLICY NUMBER
LIMITS
x
. ... "'r35702
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE [8J OCCUR
OWNER'S & CONTRACTOR'S PROT
I
6ljKI:ljA I ~
PRODUCTS - COMP/OP AGG $
PERSONAL & ADV INJURY $
EACH OCCURRENCE $
FIRE DAMAGE (Anyone fire) $
$
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 $
$
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
ANY AUTO
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
2,000,000
1,000,000
1,000,000
1,000,000
10,000
THE PROPRIETOR!
PARTNERS/EXECUTIVE
OFFICERS ARE,
OTHER
INCL
EXCL
EL DISEASE-POLICY LIMIT
EL DISEASE-EACH EMPLOYEE
DESCRIPTION OF OPERATlONS/LOCATIONSNEHICLES/SPECIAL ITEMS (LIMITS MAY BE SUBJECT TO DEDUCTIBLEs OR RETENTIONS)
CITY OF CLEARWATER IS ADDITIONAL INSURED AS RESPECTS A MONITOR SENSOR ATTACHED TO ACITY-OWNED FENCE LOCATED TO THE
NORTH OF HACIENDA GARDENS, BETWEEN SATURN AVE AND KEENE RD.
CANCEUATJO.N
CITY OF CLEARWATER
P.O. BOX 4748
CLEARWATER, FL 34618-4748
SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREO ,
THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL .....JfL DAYS WRITTEN NOTICE TO T
CERTIFICATE HOLDER NAMED HEREIN, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION R
LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE, ITS AGENTS OR REPRESENTATIVES.
RECEIVED
JUN 0 .1 2000
MARSH USA INC.
BY: John F Wesley
MM1(9/99)
~
CL i P ~U I ~ CITY CLERK DePARTMENT