CERTIFICATE OF INSURANCE (7)
MARSH USAJNC CERTIFICATE OF INSiURANC CERTIFICATE NUMBER
LOS-000088571-00
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
Marsh Risk & Insurance Services NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE
Casualty Department - 23rd Floor POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
777 So. Figueroa Street AFFORDED BY THE POLICIES DESCRIBED HEREIN.
Los Angeles, CA 90017 COMPANIES AFFORDING COVERAGE
Attn: C. Kagaoan (213) 346-5089
COMPANY
403665-GLlAL--02-03 COSF A Zurich-American Insurance Company
INSURED COMPANY
CHURCH OF SCIENTOLOGY B N/A
DBA: FLAG SERVICE ORGANIZATION
503 CLEVELAND STREET COMPANY
CLEARWATER, FL 34616 C N/A
COMPANY
D
COVERAGES
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 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION L1M ITS
LTR DATE (MMIDDIYY) DATE (MM/DDIYY)
A GENERAL LIABILITY GL09297357 -04 OS/27/02 OS/27/03 GENERAL AGGREGATE $ 2,000,000
-
X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP~PAGG $ 2,000,000
I CLAIMS MADE [8] OCCUR PERSONAL & ADV INJURY $ 1,000,000
- OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ 1,000,000
FIRE DAMAGE (Anyone fire) $ 1,000,000
MED EXP (Anyone person) $ 10,000
AUTOMOBILE LIABILITY $
f-- COMBINED SINGLE LIMIT
I-- ANY AUTO
I-- ALL OWNED AUTOS BODILY INJURY $
SCHEDULED AUTOS (Per person)
f--
I-- HIRED AUTOS BODILY INJURY $
(Per accident)
'-- NON-OWNED AUTOS
- PROPERTY DAMAGE $
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
-
- ANY AUTO OTHER THAN AUTO ONLY:
- EACH ACCIDENT $
AGGREGATE $
EXCESS LIABILITY EACH OCCURRENCE $
R UMBRELLA FORM AGGREGATE $
OTHER THAN UMBRELLA FORM $
WORKERS COMPENSATION AND I TORY LIMITS I I Ud~
EMPLOYERS' LIABILITY
EL EACH ACCIDENT $
THE PROPRIETOR! R'NCL EL DISEASE-POLICY LIMIT $
PARTNERS/EXECUTIVE
OFFICERS ARE: EXCL EL DISEASE-EACH EMPLOYEE $
10THER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS (LIMITS MAY BE SUBJECT TO DEDUCTlBLES OR RETENTIONS}
RE: .~ermit No. 9~-098 f.o.r ere9tion of temporary chain link fence on block surrounded by Ft. Harrison Ave., Pierce Street, Franklin St. and Garden Ave.
Certificate holder IS additional Insured, but only as respects liability arising out of the Named Insured's operations related to the Permit No. 98-098.
\,C111 '" un I n:ca~:J:"'{"'ii: {:iiiii {ATln~1
SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF.
THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL --3..Q DAYS WRITTEN NOTICE TO THE
CITY OF CLEARWATER CERTIFICATE HOLDER NAMED HEREIN. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
112 SOUTH OCEALA A VEN U E
CLEARWATER, FL 33758 LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE. ITS AGENTS OR REPRESENTATIVES.
MARSH USA INC.
BY: John F Wesley ~
M~i~(9/99) VAI,,;lD ASi (:)iF':: OS/2<4/02