CERTIFICATE OF INSURANCE
',.
ACORDN
CERTIFICAli
OF LIABILITY INSU
NCJ;;ID xx
~E-01 02/13/01
THIS CERTIFICATE IS I ~UED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
DATE (MMlDDIYY)
PRODUCER
~he Addis Group, Inc.
2300 Renaissance Boulevard
King of Prussia PA 19406-2772
Phone: 610-279-8550 Fax:610-279-8543
INSURED Lane Industries, Inc.
Lane Hospitality, Inc.
Hospita11ty Investment Assoc.
Lane Hotel Investments II, L.P
One Lane Center
1200 Sher.mer Road
Northbrook, IL 60062
INSURERS AFFORDING COVERAGE
INSURER A:
INSURER B:
INSURER C:
INSURER 0:
INSURER E:
American Zurich
American Guarantee & Liabilit
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
INSR TYPE OF INSURANCE POLICY NUMBER POL,\f~ EFFECT}YE POLl%I;~':'l~WN LIMITS
LTR DATE MM/DDIYY DATE MMIDDIYY
GENERAL. blABIL-lTY- - --- - ---- -- -- ---" -, - --- ---- EAGI+OCCURRENCE $1:,00-0 i o Oil
-
A X COMMERCIAL GENERAL LIABILITY GL06847038 03/01/01 03/01/02 FIRE DAMAGE (Anyone fire) $ 500,000
. ~:.... I CLAIMS MADE [!J OCCU~ MED EXP (Anyone person) $ 10,000
X EMP BENEFITS PERSONAL & ADV INJURY $1,000,000
1,,: X LIQUOR LIAB .... GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $1,000,000
I .nPRO- n
POLICY JECT LOC
':', AUTOMOBILE LIABILITY
- COMBINED SINGLE LIMIT $1,000,000
B ~ ANY AUTO '. BAP6847040 03/01/01 03/01/02 (Ea accident)
~ ALL OWNED AUTOS " BODILY INJURY
$
~ SCHEDULED AUTOS (Per person)
~ HIRED AUTOS BODILY INJURY
$
~ NON-OWNED AUTOS (Per accident)
- PROPERTY DAMAGE $
(Per accidenl)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
=:J OCCUR D CLAIMS MADE AGGREGATE $
.'. $
~ DEDUCTIBLE $
" RETENTION $ $
.... , WORKERS COMPENSATION AND " X TORY LIMITS I IUJ,H-
ER
EMPLOYERS' L1ASlLTIY --_.,- ,- . ---".~----- '- -. -- - '0 3701/i)"2 - $LOOO,boo
.. A WC06847039 03/01/01 E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE $1,000,000
.... E.L. DISEASE - POLICY LIMIT $1,000,000
OTHER
,.
B Automobile BAP6847040 03/01/01 03/01/02 Comp Ded: $250
Physical Damaae ColI Ded: $500
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS m ~ ~ ~ ~ \W ~ rnl
For operations and activities of the licensee DBA Holiday Inn Sun SprE
located upon the property more fully described in the license agreemeI
effective 10/1/96. Certificate Holder is recognized as additional inl ~.m 2 0 ? r i
,~-!
---!
CERTIFICATE HOLDER I y I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION PIJRII~" v Anu~
, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEF ION
CLEAR-1
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
City of Clearwater -
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Real Estate Services
ATT: Earl Barrett IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
P.O. Box 4748 REPRESENTATIVES.
Clearwater, FL 33758-4748 >O~ <...J . ?.../~-
I Gary W. Warren, CPCU, ARM
ACORD 25-S (7/97)
@ ACORD CORPORATION 1988