CERTFICATE OF INSURANCE
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ACORDN ....g.IS.~,..I..~.I.~.l.iliE.....~.f......l...lllB.I..~.I.m'(......I..~.~.I..J................... . ...~.q.i~E~~.i....................... DA~~;;/;~~Y~
PRODUCER ... . ... ... ..... ..... . ..... .. F ....... .... THIS CERTIFICATE IS I. ~UED AS A MATTER OF INFORMATION
The Addi s Group, Inc . ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Sui te 200 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
100 Four Falls Corporate Ctr. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
West Conshohocken PA 19428-2976 COMPANIES AFFORDING COVERAGE
Gary W. Warren, CPCU, ARM
Phone No. 610-832-2100 Fax No. 610-825-9136
INSURED
Lane Industries, Inc.
Lane Hospitality, Inc.
Hospitality Investment Assoc.
One Lane Center
1200 Shermer Road
Northbrook, IL 60062
COMPANY
A American Zurich
COMPANY
B American Guarantee & Liability
COMPANY
C
COMPANY
D
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MM/DDNY) DATE (MM/DDNY)
LIMITS
GENERAL LIABILITY
A COMMERCIAL GENERAL LIABILITY GL06847 03 8
CLAIMS MADE [i] OCCUR
OWNER'S & CONTRACTOR'S PROT
03/01/98
GENERAL AGGREGATE $ 2 , 000, 000
03/01/99 PRODUCTS-COMP/OP AGG $ 1,000,000
PERSONAL & ADV INJURY $ 1,000,000
EACH OCCURRENCE $ 1,000,000
FIRE DAMAGE (Anyone fire) $ 500 , 00 0
MED EXP (Anyone person) $ 10 , 0 0 0
B
X EMP BENEFITS
LIQUOR LIAB
AUTOMOBILE LIABILITY
X ANY AUTO
X ALL OWNED AUTOS
X SCHEDULED AUTOS
X HIRED AUTOS
X NON,OWNED AUTOS
BAP6847040
03/01/98
03/01/99
COMBINED SINGLE LIMIT
$1,000,000
BODILY INJURY
(Per person)
$
BODILY INJURY
(Per accident)
PROPERTY DAMAGE $
GARAGE LIABILITY
ANY AUTO
AUTO ONLY, EA ACCIDENT $
OTHER THAN AUTO ONLY:
EACH ACCIDENT $
AGGREGATE $
EACH OCCURRENCE
AGGREGATE
.A THEi"ROPRiETGRI'"
PARTNERS/EXECUTIVE
OFFICERS ARE:
OTHER
,---,
'XINtL
EXCL
W-C0-6847039
03/0T/9"B
03/0119"9
$1,000,000
ElDTSEASFPOUCY liMIT - $1;000, 000
EL DISEASE - EA EMPLOYEE $ 1, 00 0 , 00 0
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
B Automobile
Physical Damage
BAP6847040
03/01/98
03/01/99
Comp Ded:
ColI Ded:
$250
$500
DESCRIPTION OF OPERA TIONS/LOCA TIONSNEHICLES/SPECIAL ITEMS
For operations and activities of the licensee DBA Holiday Inn Sun Spree
located upon the property more fully described in the license agreement
effective 10/1/96. Cert1ficate Holaer is recognized as additional insured.
CANCELLATION
CLEAR-1
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTA~~ ~ ~. t-../ ~
Gary W. Warren, CPCU, AIiM
..........(g).AqQRP.qq~~PMtlQl\l..1~M
City of Clearwater
ATT: Earl Barrett, Risk Mgmt
P.O. Box 4748
Clearwater, FL 33758-4748
. A99~P2$--$(1f~~)
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