CERTIFICATE OF INSURACE WITH ATTACHED EXHIBIT A
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ISSUE DATE (MMIDDIYY)
March 1, 1993
Companies Affording Coverage
.company A Zurich American
Letter '
Company B' American Guarantee
Letter
INSURED
Lane Industries, I f~t'rtany C
Lane Hospitality, Inc. FEH 26 1993 D
One Lane Center f~t'rtany
1200 Shermer Road
Northbrook,IL 600ft f~t'rtany E
COVERAGES This Certifi(ate of Insurance or Binder evidences the limits of liability In effect at the inception ofthe policies shown. Note the
General,XS aggregate limits. All claims paid exhaust the aggregate limits and reduce the amount of insurance in force.
Arthur J. Gallagher & Co. - Chicago Metro
1101 31st Street, Suite 100' ,
P.O. Box 579
Downers Grove, J
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO
RIGHTS UPON THE 'CERTlFfCA TE HOLDER, - THIS 'CERTlFICA TE DOES NOT AMEND,
EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
c @mrrw
Crum & Forster/U. S. Fire Insurance Co.
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELQW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED
NOTWITHSlANDING ANY REQUIREMENT, TERM OR CONDITIOJl.!'OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTlFICA TE MA Y
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 TYPE Of INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION ALL LIMITS IN THOUSANDS
LTR OME (MMIOOIYY) DATE (MMIOOIYY)
A General Liability GLO 6847038-01 3-1-93 3-'-94 GENERAL AGGREGA TE S 2,000,
, !:'''Icial General liability PRODUCTS,COMPIOPS AGGREGA TE S 1,000,
o Claims Made IBl Occurrence PERSONAL & ADVERTISING INJURY S 1,000,
DOwners' & Contractors' Protective EACH OCCURRENCE S 1,000,
IBl Employee Benefits fIRE DAMAGE (Any OM ",./ S 100,
" .1":'.'--';' t \ ~
I,' . MEDICAL EXPENSE (Anyon. "."on/ S 5.
I A Automobile Liability SAP 6847040-01 3-1-93 3-1-94 Combined S 1 ,000,
IBl Any Auto Single Limit
IBl All Owned Autos Physical Damage: S
IBl Scheduled Autos
IBl H ired Autos $250 Comprehensive
IBl Nonowned Autos $500 Collision S
o Garage Liability S
0
Excess Liability 523643415 3-1-93 3-1-94 Each
C Occurrence
IBl Umbrella Form *Per Location Aggregate
0 Other Than Umbrella Form S 15,000
B Workers' Compensation WC 6847039-01 3-1-93~_ ...~ 3~1-94__ Statutory
And ,I $ 500, (EACti ACCIDENT)
Employers' liability I $ 500,
(DISEASE - POLICY LIMIT)
$ 500, (DISEASE, EACH EMl'lOVU)
Other
Description of OperationsILocationsIVehiclesISpecia/ltems: For operations and activities of the Licensee, d/b/a Clearwater
Beach Hilton, located upon the property more fully described in the License Agreement dated 5/18/87 - Exhibit A attached
hereto and made a part thereof.
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City of Clearwater Mm> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCElED BEFORE THE
':i::!:;l EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30
AHn: Risk Management~tii~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT BUT
POBox 4748 ~i:j:i:!:l FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY O~ ANY
. , HM KIND UPON THE COMPANY, ITS AGENTSOR Il.EPRESENTATlVES,
Clearwater, FL 34618-4748~i;1,;~ Authorized Representative -=r L I )
M~ JAMES T. KEOUGH ~ -, ()"-'"
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