CERTIFICATE OF INSURANCE
PRODUCER
Marsh Risk & Insurance Services
Casualty Department - 23rd Floor
n7 So. Figueroa Street
Los Angeles, CA 90017
Attn: C. Kagaoan (213) 346-5089
.CERtI6l~!I.., ~~~~~~~::~;:;O
THIS CERTIFICATE IS ISSUED AS A 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-01/02
COSF
COMPANY
A Zurich-American Insurance Company
COMPANY
B N/A
INSURED
CHURCH OF SCIENTOLOGY
DBA: FLAG SERVICE ORGANIZATION
503 CLEVELAND STREET
CLEARWATER, FL 34616
COMPANY
C
COMPANY
D
THIS IS TO CERTIFY TliAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO TliE INSURED NAMED HEREIN FOR TliE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTliER DOCUMENT WITH RESPECT TO WHICH TliE CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TliE TERMS. CONDITIONS AND EXCLUSIONS OF SUCH POLICIES. LIMITS SHOWN
MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO
LTR
A GENERAL LIABILITY
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MM/DDIYYJ DATE (MM/DDIYY)
LIMITS
GL09297357 -03
05/27/01
05/27/02
GENERAL AGGREGATE
PRODUCTS-COM~OPAGG
PERSONAL & ADV INJURY
EACH OCCURRENCE
$ 2,000,000
$ 2,000,000
$ 1,000,000
$ 1,000,000
$ 1,000,000
$ 10,000
$
$
$
$
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE ~ OCCUR
OWNER'S & CONTRACTOR'S PROT
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
COMBINED SINGLE LIMIT
BODILY INJURY
{Per person),....
, . .
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
GARAGE LIABILITY
THE PROPRIETORl
PARTNERSIEXECUTNE
OFFICERS ARE:
H
INCL
EXCL
AUTO ONLY - EA ACCIDENT $
OTHER THAN AUTO ONLY:
EACH ACCIDENT
AGGREGATE
EACH OCCURRENCE
AGGREGATE
ANY AUTO
EXCESS LIABILITY
UMBRELLA FORM
OTHEi'\ TliAN UMBRELLA FOi'\M
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
DESCRIPTION OF OPERATlONS/LOCATlONSNEHICLES/SPECIAL ITEMS (LIMITS MAY BE SUBJECT TO DEDUCTIBLEs OR RETENTIONS)
CIlY OF CLEARWATER IS ADDITIONAL INSURED AS RESPECTS A MONITOR SENSOR ATTACHED TO ACITY-OWNED FENCE LOCATED TO THE
NORTH OF HACIENDA GARDENS, BElWEEN SATURN AVE AND KEENE RD.
CERTIFICA TE,HOLDER
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CANCELLATION
CITY OF CLEARWATER
P.O. BOX 4748
CLEARWATER, FL 34618-4748
SHOULD APl'( OF THE POlICIES DESCRIBED HEREIN BE CANCEllED BEFORE THE EXPIRATION DATE THEREO ,
THE INSURER AFFORDING COVERAGE WIll ENDEAVOR TO MAil -3fL DAYS WRITTEN NOTICE TO
CERTIFICATE HOLDER NAMED HEREIN, BlIT FAIlURE TO MAil SUCH NOTICE SHAll IMPOSE NO OBUGATION R
UABIUTY OF APl'( KINO UPON THE INSURER AFFORDING COVERAGE, ITS AGENTS OR REPRESENTATIVES.
MARSH USA INC.
BY: John F Wesley
. VAl.iOASOF!05/24/01