CERTIFICATE OF INSURANCE (3)
ACORDN CIiR~'~ICAT'O~ ~,IAaILI~V'I~;~IJMNC~~~l',' DA;~7~~~';~ ";"
PRODUCER THIS CERTIFICATE IS IS~ED AS A MATTER OF INFORMATION
The Addis Group, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Suite 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
COMPANY
A American Zurich
COMPANY
B American Guarantee
Lane Industries, Inc.
Lane Hospitality, Inc.
One Lane Center
1200 Shermer Road
Northbrook, IL 60062
COVERAGES
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.
COMPANY
C
COMPANY
D
CO
LTR-
lYPE.9F !N~URANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
- ~iMMlOOl'A't-- - DATE (MMIODIVY), -.-
LIMITS
GENERAL LIABILITY
I--
A X COMMERCIAL GENERAL LIABILITY GLO 6 8 4 7 038
~ =:J CLAIMS MADE ~ OCCUR
OWNER'S & CONTRACTOR'S PROT
03/01/97
GENERAL AGGREGATE $ 2,000,000
03/01/98 PRODUCTS.COMP/OPAGG $ 1,000,000
PERSONAL&ADV INJURY $ 1,000,000
EACH OCCURRENCE $ 1,000,000
FIRE DAMAGE (Any one fire) $ 500,000
MED EXP (Anyone person) $ 5 , 000
I--
~ EMP BENEFITS
LIQUOR LIAB
AUTOMOBILE LIABILITY
I--
B X ANY AUTO
I--
X ALL OWNED AUTOS
I--
X SCHEDULED AUTOS
I--
~ HIRED AUTOS
X NON-OWNED AUTOS
~
BAP6847040
03/01/97
03/01/98
COMBINED SINGLE LIMIT
$1,000,000
BODILY INJURY
(Per person)
$
ANY AUTO
RECEIVED
MAt 1 2 200}
RISK MANAGEME NT
BODILY INJURY
(Per accident)
$
~
PROPERTY DAMAGE
$
EXCESS LIABILITY
RUMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
. -EMPLOYERS'LIABILlTY - _.-
AUTO ONLY - EA ACCIDENT $
OTHER THAN AUTO ONLY: .: '.'i' ,":> ':" ,".." '.,
EACH ACCIDENT $
AGGREGATE $
EACH OCCURRENCE $
AGGREGATE $
$
-..---- --x1~8R~T~~VTs+19J~~ .-, -<-
EL EACH ACCIDENT $ 1,000,000
03/01/98 EL DISEASE.POLlCYLIMIT $ 1,000,000
EL DISEASE - EA EMPLOYEE $ 1,000,000
GARAGE LIABILITY
-
-
I--
---.
A THE PROPRIETOR!
PARTNERS/EXECUTIVE
OFFICERS ARE:
OTHER
RINCL
EXCL
WC06847039
03/01/97
B Automobile
Physical Damage
BAP6847040
03/01/97
03/01/98
Comp Ded:
Coll Ded:
$250
$500
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESlSPECIAL 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.
~ERTIFI:ATI; HOL~ _
A<j'f:j~/~~
~ City of Clearwater
ATTN: Leo Schrader, Risk
P.O. Box 4748
Clearwater, FL 34618-4748
CLEAR-1
CANCELLATION ..., {"""'<i{T:<
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
.dL 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 REPRESENTATIVE "":l;{i. ~~l ~rt ('~j~'4~ ~_"'-_"-
Gary W. Warren, CPctr;~,,!f - ,- "-"~ .........,
'.."~ACO~t:!"'e:ORf!c>'~i;jjjOillli<i~:98~
Mqm;:;'~17
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