CERTIFICATE OF INSURANCE (4)
PRODUCER
Marsh Risk & Insurance Services
Casualty Department - 23rd Floor
777 So. Figueroa Street
Los Angeles, CA 90017
Attn: C. Kagaoan (213) 346-5089
CERTIFICATE NUMBER
LOS-000088520-02
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-G L/ ALn03-04
COSF
COMPANY
A Zurich-American Ii ,.urance Company
COMPANY
B
INSURED
CHURCH OF SCIENTOLOGY
DBA: FLAG SERVICE ORGANIZATION
503 CLEVELAND STREET
CLEARWATER, FL 33755
COMPANY
C N/A
COMPANY
D
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. AGGREGATE
LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MM/DDNYI DATE (MM/DDNY)
LIMITS
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE [8] OCCUR
OWNER'S & CONTRACTOR'S PROT
PRODUCTS - COMP/OP AGG
PERSONAL & ADV INJURY
EACH OCCURRENCE
COMBINED SINGLE LIMIT
$ 2,000,000
$ 1,000,000
$ 1,000,000
$ 1,000,000
$ 10,000
$
$
$
$
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
BODILY INJURY
(Per person)
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
THE PROPRIETOR!
PARTNERS/EXECUTIVE
OFFICERS ARE:
INCL
EXCL
AUTO ONLY - EA ACCiDENT
OTHER THAN AUTO ONLY:
EACH ACCIDENT
AGGREGATE
EACH OCCURRENCE
AGGREGATE
GARAGE LIABILITY
ANY AUTO
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
EL DISEASE-POLICY LIMIT
EL DISEASE-EACH EMPLOYEE $
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
CITY OF CLEARWATER IS ADDITIONAL INSURED AS RESPECTS A MONITOR SENSOR ATTACHED TO A CITY-OWNED FENCE LOCATED TO THE
NORTH OF HACIENDA GARDENS, BETWEEN SATURN AVE AND KEENE RD,
CITY OF CLEARWATER
P.O. BOX 4748
CLEARWATER, FL 33758-4748
SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,
THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL --3..0 DAYS WRITTEN NOTICE TO THE
CERTIFICATE HOLDER NAMED HEREIN, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE, ITS AGENTS OR REPRESENTATIVES, OR THE
ISSUER OF THIS CERTIFICATE.
MARSH USA INC.
BY: John F Wesley