CERTFICATE OF LIABILITY INSURANCE
CERTIFICAT,
OF LIABILITY INSURANCEf~E~~l DA~E~~~~;;9
THIS CERTIFICATE IS I UED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERT;'~ICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
PRODUCER
The Addis Group, Inc.
Suite 200
100 Four Falls Corpora~e Ctr.
West Conshohocken PA 19428-2976
Phone: 610-832-2100 Fax:610-825-9136
INSURERS AFFORDING COVERAGE
INSURED
INSURER A:
INSURER B:
INSURER C:
INSURER D:
INSURER E:
American Zurich
American Guarantee & Liabilit
Lane Industries, Inc.
Lane Hospitality, Inc.
Hospita11ty Investment Assoc.
One Lane Center
1200 Shermer Road
Northbrook, IL 60062
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 S~BJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I~ft TYPE OF INSURANCE POLICY NUMBER POLl9~F~~E PJ'Al{~~~~b~~N LIMITS
DATE IDD
GENERAL LIABILITY --"". EACH OCCURRENCE $1,000,000
-
A X COMMERCIAL GENERAL LIABILITY GL06847038 03/01/99 03/01/00 FIRE DAMAGE (Anyone fire) $ 500,000
. i CU\IMS MADE [~J OCCUR _d 10,000
MED EXP (Anyone person) $
~ EMP BENEFITS PERSONAL & ADV INJURY $1,000,000
LIQUOR LIAB GENERAL AGGREGATE $2,000,000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 1,000,000
I nPRO- n
POLICY JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $ 1,000,000
B ~ ANY AUTO BAP6847040 03/01/99 03/01/00 (Ea accident)
~ ALL OWNED AUTOS I BODILY INJURY
I (Per person) $
~ SCHEDULED AUTOS
~ HIRED AUTOS BODILY INJURY
$
~ NON-OWNED AUTOS (Per accident)
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
=1 ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
:=J OCCUR D CLAIMS MADE AGGREGATE $
$
=1 DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND X I TORY'LIMITS I IU1H-
ER
A EMPLOYERS' LIABILITY WC06847039 03101./!t9 03/01/00 $1..-000,OQO
EL. EACH ACCIDENT
- ..
EL. DISEASE - EA EMPLOYEE $1,000,000
EL. DISEASE - POLICY LIMIT $1,000,000
OTHER
B Automobile BAP6847040 03/01/99 03/01/00 Comp Ded: $250
Physical Damaae Coll Ded: $500
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
For operations and activities of the licensee DBA Holiday Inn Sun Spree
located upon the property more fully described in the license agreement
effective 10/1/96. Certificate Holder is recognized as additional insured.
CERTIFICATE HOLDER I y I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
CLEAR-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
-
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
City of Clearwater IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
ATT: Earl Barrett, Risk Mgmt
P.O. Box 4748 REPRESENTATIVES.
Clearwater, FL 33758-4748 AUTHORIZED REPRESENTATIVE X-J ~ <1:....-; , L...J ~ --- ~ '---
, Garv W. Warren, CPCU ARM
ACORD 25-S (7/97)
.. ACORD CORPORATION 1991