CERTIFICATE OF INSURANCE (5)
A.~..IU."
.....IIIIIIII,;.llllllllllli~i~l)...i O~05$'" I~U~~~;~'<(::;~~~"'"
.'.........U......iUU"..............l, 1I.;..U.U.........U/...........................(.1) ..'.................... ..... ....... .,.. ... 0 2 / 2 4 / 9 5
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 GUARANTEE INSURANCE CO
LETIER
COMPANY CU S FIRE INSURANCE CO
LETIER
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 NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICAtE MAY BE ISSUED OR MAY PERTAI"!.. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLl..,IES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
0 POLICY EFFECTIVE POLICY EXPIRATION
TYPE OF INSURANCE POLICY NUMBER LIMITS
TR ATE (MM/DDIYV) DATE (MMIDDIVY)
GL06847038 03/01/95 03/01/96 GENERAl AGGREGATE
PRODUCTS-COMP/OP AGG,
PERSONAL & ADV, INJURY
EACH OCCURRENCE
FIRE DAMAGE (Anyone fire)
MED,EJ(p, (Anyone person)
BAP6847040 3/01/95 3/01/96 COMBINED SINGLE
LIMIT
AlL OWNED AUTOS 80DIL Y INJURY
SCHEDULED AUTOS (Per person) $
HIRED AUTOS 80DIL Y INJURY
NON-OWNED AUTOS (Per accident) $
GARAGE LIABILITY
PROPERTY DAMAGE
5530228245 03/01/95 3/01/96 EACH OCCURRENCE
OTHER THAN UMBRELLA FORM
WC06847039 03/01/95
AND
EMPLOYERS' LIABILITY
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
OR OPERATIONS AND ACTIVITIES OF THE LICENSEE DBA:CLEARWATER BEACH HILTON
OCATED UPON THE PROPERTY MOR~ FULLY DESCRIBED IN THE LICENSE AGREEMT DATED
1 87 q
1M.' '.
;i' ...... ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
C Jl9""~ DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
CITY OF CLEARWATER 71; CI. .1 .4,1,1 MAIL..3.0..- DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
RI SK MGMT t4'J(..;;; LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
POBOX 474 8 "''''1: LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGEN1S OR REPRESENTATIVES.
CLEARWATER FL 34618-4748 ,/
HH AUTHORIZED REPRESENTATIVE ,'/"., n ,Ii J
I (0 .f .'"\"..............-..,s6;",(...,"',,',o:~~_
.~'i~6~QQ"ijg~,inll1~"
Igpijplt']iitt'.,............y>>................... .
ee--6l/,$/JN' S~~ .-,
~