CERTIFICATE OF INSURANCE (5)
PRODUCER
Marsh Risk & Insurance Services
Casualty Department - 23rd Floor
777 So. Figueroa Street
Los Angeles, CA 90017
AUn: C. Kagaoan (213)346-5089
CERTIFICATE NUMBER
LOS-000088521-01
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-GLlAL--03-04
COMPANY
A Zurich-American Insurance Company
COMPANY
B
COSF
INSURED
CHURCH OF SCIENTOLOGY
FLAG SERVICE ORGANIZATION, INC,
210 S, Fort Harrison Ave.
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
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MM/DDfYYI DATE (MM/DDfYYI
TYPE OF INSURANCE
A GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE ~ OCCUR
OWNER'S & CONTRACTOR'S PROT
OS/27/03
GENERAL AGGREGATE
PRODUCTS-COM~OPAGG
PERSONAL & ADV INJURY
EACH OCCURRENCE
OS/27/04
GL09297357-05
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
BODILY INJURY
(Per person)
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
OTHER THAN AUTO ONLY,
ANY AUTO
EXCESS LIABILITY
EACH ACCIDENT $
$
$
$
$
AGGREGATE
EACH OCCURRENCE
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
AGGREGATE
THE PROPRIETOR!
PARTNERS/EXECUTIVE
OFFICERS ARE:
HER
INCL
EXCL
EL DISEASE-POLICY LIMIT
EL DISEASE-EACH EMPLOYEE $
LIMITS
$ 2,000,000
$ 2,000,000
$ 1,000,000
$ 1,000,000
$ 1,000,000
$ 10,000
$
$
$
$
DESCRIPTION OF OPERATIONS/LOCATlONSNEHICLES/SPECIAL ITEMS
Re: The motion sensor COS Flag ORG. is aUachin to the fence they share on the same side of the property as the nursery next to their property.
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.ll 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.