CERTIFICATE OF INSURANCE (6)
CERTIFICATE NUMBER
LOS-000088571-02
PRODUCER
Marsh Risk & Insurance Services
Casualty Department - 23rd Floor
777 So, Figueroa Street
Los Angeles, CA 90017
Atln: C. Kagaoan (213) 346-5089
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
403665-GUALn04-04 COSF
INSURED
CHURCH OF SCIENTOLOGY
DBA: FLAG SERVICE ORGANIZATION
503 CLEVELAND STREET
CLEARWATER, FL 33755
COMPANY
A Zurich-American Insurance Company
COMPANY
B
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 LIMITS
DATE (MMlDDlYY) DATE (MMIDDNY)
OS/27103 08115104 GENERAL AGGREGRATE $ 2,000,000 .
PRODUCTS-COMP/OP AGG $ 2,000,000
PERSONAL & ADV INJ URY $ 1,000,000
EACH OCCURRENCE $ 1,000,000
FIRE DAMAGE (Anyone fire) $ 1,000,000
MED EXP (Anyone person) $ 10,000
COMBINED SINGLE LIMIT $
BODILY INJURY $
(Per person)
BODIL Y INJURY $
(per acciden~
PROPERTY DAMAGE $
AUTO ONL Y- EA ACCIDENT $
OTHER THAN AUTO ONLY:
EACH ACCI DENT
AGGREGATE
EACH OCCURRENCE
AGGREGATE
EL DISEASE-POLICY LIMIT
EL DISEASE-EACH EMP~OYEE
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE 0 OCCUR
OWNER'S & CONTRACTOR'S PROT
X Deductible -o-
X Contractual Liability Included
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON.OWNED AUTOS
GL09297357 -05
GARAGE LIABILITY
ANY AUTO
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
THE PROPRIETOR!
PARTNERs/EXECUTIVE
OFFICERS ARE:
OTHER
INCL
EXC<L
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
RE: Permit No. 98-098 for erection of temporary chain link fence on block surrounded by Ft. Harrison Ave., Pierce Street, Franklin St. and Garden Ave. Certilicate holder is
additional insured, but only as respects liability arising out of the Named Insured's operations related to the Permit No. 98-098.
CITY OF CLEARWATER
112 SOUTH OCEALA AVENUE
CLEARWATER, FL 33758
SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL 30 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.