INTER OFFCE MEMO REGARDING CERTIFICATE OF INSURANCE
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CITY OF CLEARWATER
INTEROFFICE CORRESPONDENCE SHEET
TO:
Susan Stephenson
Documents and Records Supervisor
City Clerk's Office
Contract dated
Lease dated
Special Event Application dated
Miscellaneous Activity
Unknown Activity dated
FROM:
Leo W. Schrader, Risk Manager
SUBJECT:
Certificate of Insurance For:
This office has received the attached Certificate of Insurance Form presumably
for the document identified above.
1. This Certificate of Insurance is in compliance with the insurance
requirements contained in the contract identified above.
2. This Certificate of Insurance is not in compliance with the insurance
requirements in the contract identified above for the following
reasons:
The liability limits shown are less than the required amounts.
The type of liability policy provided is a "claims made policy
when the contract called for an "occurrence" policy.
Worker's Compensation Insurance coverage is not provided.
Flood insurance coverage is not provided.
Plate glass coverage is not provided.
The City is not shown as an additional insured.
The Notice of Cancellation is for a shorter period than required.
The policy deductible shown is not provided for by the contract
documents.
3.
This Certificate mayor may not be in compliance with a City
contract, bu~th' office cannot offer an opinion because neither
contract nor t purpose of the Certificate of Insurance can be
identified.
the
cc: Department (If no department is
shown, it is because no department can be identified.)
insur-l.mem
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.... PRINTED ON RECYCLED PAPER
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THIS CERTIFICATE IS ISSUED 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.
COMPANIES AFFORDING COVERAGE
PRODUCER
RTHUR J GALLAGHER & CO
HICAGO METRO
TTN PAULA G 708-9680333
101 31ST ST, PO BOX 579
OWNERS GROVE IL 60515
COMPANY A ZURICH AMERICAN INSURANCE CO
LETTER
COMPANY B AMERICAN-ZURICH INSURANCE CO
LETTER
COMPANY CU S FIRE INSURANCE CO
LETTER
COMPANY D
LETTER
COMPANY E
ANE INDUSTRIES, INC.
ANE HOSPITALITY, INC.
NE LANE CENTER
1200 SHERMER ROAD
ORTHBROOK IL 60062
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED NOlWlTHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICAtE MAY BE ISSUED OR MAY PERTAI'i.. THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLl"IES. LIMITS SHOWN II.AY HAVE BEEN REDUCED BY PAID CLAIMS.
0 POLICY EFFECTIVE POLICY EXPIRATION
TYPE OF. INSURANCE POLICY NUMBER LIMITS
TR ATE (MM/DDIYY) DATE (MM/DDIYY)
GL06847038 03/01/96 03/01/97 GENERAL AGGREGATE $ 2 000
PRODUCTS-COMP/OP AGG, $ 1 000
PERSONAL & ADV, INJURY $ 1 000
EACH OCCURRENCE $ 1 000
FIRE DAMAGE (Anyone fire) $ 100
MED,EXP, (Anyone person) $
BAP 4~~ ~ ~ \Yl 03/01/97 COMBINED SINGLE
I -, LIMIT $ 1 000
. \
,...; \
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS APR 0 2 19% (Per person) $
HIRED AUTOS BODILY INJURY
NON-OWNED AUTOS (Per acciden~ $
GARAGE LIABILITY RISK MANAGE
PROPERTY DAMAGE
$
5530354623 3/01/97 EACH OCCURRENCE
WORKER'S COMPENSATION WC06847039 03/01/96 03/01/97
AND
DISEASE-POLICY LIMIT
EMPLOYERS' LIABILITY
DISEASE-EACH EMPLOYEE
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESI5PECIAL ITEMS
OR OPERATIONS AND ACTIVITIES OF THE LICENSEE DBA HOLIDAY INN SUN SPREE
OCATED UPON THE PROPERTY MORE FULLY DESCRIBED IN THE LICENSE AGREEMT DATED
1/87
CITY OF CLEARWATER
RISK MGMT
POBOX 4748
CLEARWATER FL 34618-4748
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL..3..0..-- 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 ANY, ITS AGENp OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE