CERTIFICATE OF INSURANCE (3)
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Marsh Risk & Insurance Services
Casualty Deparbnent - 23rd Floor
777 So, Figueroa Street
Los Angeles, CA 90017
AIIn: C. Kagaoan (213) 346-5089
CERTIFICATE NUMBER
LOS-000088520-01
THIS CERTFICATE IS ISSUED AS A MATTER OF INFORMATION ONL V 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 ElY THE POLlClE S DESCRIBED HEREIN.
COMPANIES AFFORDING COVERAGE
665-GUAL--02-03
COSF
C~PA'W
A Zurich-American Insurance Company
INSURED
CHURCH OF SCIENTOLOGY
DBA: FLAG SERVICE ORGANIZATION
503 CLEVELAND STREET
CLEARWATER, FL 33755
Ca.1PANY
B N/A
Ca.1PANY
C N/A
Ca.1PANY
D
THIS IS TO CERTIFY THAT PO-ICIES OF INSJRANCE DESCRIBED HER8N HAVE BEEN ISSUED TO THE INSJRED NNoIIED HEREIN FOR THE PO-ICY PERIOD INDICATED.
NOTIMTHsrANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DoaJMENTWlTH RESPECT TOIM-lICH THE CERl1FICATE MAY BE ISSJED OR MAY
PERTAIN, THE INSJRANCE AFFORDED BY THE POUCES DESCRIBED HER8N IS SUBJECT TO ~L THE TERMS, CONDmONS AND EXa.USONS OF SUCH POLlOES. AGGREGATE
LIMITS s-iOVI.N MAY HAVE BEEN REDUCED BY PAJD a.A1MS.
CO
LTR
A GENERAL L1ABIUlV
1YPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POlICY EXPIRATION
DATE (MM/DDIYY) DATE IMMIDDIYY)
L1M ITS
GL09297357 -04
OS/27/02
05127/03
GENERAL AGGREGATE
PRODUCTS - COM PlOP AGG
PERSJNI'l & ADVINJURY
EACH OCCURRENCE
CO\/IBINED SNGLE LIMIT
$ 2,000,000
$ 2,000,000
$ 1,000,000
$ 1,000,000
$ 1 ,000,000
$ 10,000
$
$
$
$
X COMMERClI'l GENERAL LI ABILITY
CLAlMSMJlDE ~ OCCUR
<MINER'S & CONTRACTOR'S PROf
AUTOMOBILE LIABILITY
MlY AUTO
i'lL CNVNED AUTOS
OCHEDULED AUTOS
HIRED AUTOS
NO'J-OWNED AUTOS
BODILYINJJRY
(per p......,)
BODILYINJJRY
(per accident)
PROPERTY DAMAGE
INCL
EXCL
AUTO ONLY -EAACClDENT
OTHER THAN AUTO ONLY:
EACH ACODENT
AGGREGATE
EACH OCaJRRENCE
AGGREGATE
GARAGE LIABILI1Y
MlY AUTO
EX CES S L1ABILI1Y
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMP LOVERS" LIABILrlV
THE PROPRIETORI
PARTNERSlEXECUTIVE
CFFICERSARE:
OT R
EL DISEASE-PO-ICY LIMIT
EL DISEASE-EACH EMPLOYEE
DESCRPTION OF OPERATlONS/LOCATIONS/VEHICLES/SPECLQL ITEMS
CITY OF CLEARWATER IS ADDITIONAL INSURED AS RESPECTS A MONITOR SENSOR ATTACHED TO A CITY-OV\lNED FENCE LOCATED TO THE
NORTH OF HACIENDA GARDENS, BElWEEN SATURN AVE AND KEENE RD.
CI1Y OF CLEARWATER
P.O. BOX 4748
CLEARWATER, FL 33758-4748
SHOlA..D Atff OF THE F'OlICES DESCRIBE 0 H:RE1N BE CANCaLED BEFORE THE EXPIRATION DATE THEREOF,
THE INSlRER AFFORDING COVERAGE IMLL ENDEAVOl. TO fvl'\IL -D DAYS WRITTEN NOTICE TO THE
CERnFICATE HeLDER NAM!o HEREIN, BUT FAILURE TO MAlL SUCH NOTICE SHALL IWOSE NO OBUG'lnON Ol.
UABIUTYOF ANY KIND UPONTH: INSJO.ERAFFORDING COIERAGE, ITS AGENTS OR REPRElCNTATlVESi OR THE
ISSUER OF THIS CERnFICATE