CERTFICATE OF INSURANCE- PARKING LCENSE
COMPANY
LETTER
COMPANIES AFFORDING COVERAGES-
A CIGNA Companies
Julius Moll & Son, Inc.
6160 N. Cicero Ave. Suite 506
Chicago IL 60646
(312) 286-7737
COMPANY
LETTER
NAME ANO ADDRESS OF INSURED
COMPANY
LETTER
Lane Hotels, Inc. etal
Lane Clearwater Limited
Clearwater BEach Hilton
715 S. Gulfview Blvd
Clearwater FL 34630
?artnership
Inn
COMPANY
LETTER
A
B
C
D
E
B
C
D
E
COMPANY
LETTER
This is to certify that pOlicies of insurance listed below have been issued to the insured named above and are in force at this time. 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 oolicies.
COMPANY
LETTER
.'
Limits of Liability in Thousands (
OCC~~~~NCE AGGREGATE
TYPE OF INSURANCE
POLICY NUMBER
POLICY
EXPIRATION DATE
GENERAL LIABILITY
A
SVPD1151277A
12/8/88
[3 COMPREHENSIVE FORM
[3 PREMISES-OPERATIONS
o EXPLOSION AND COLLAPSE
HAZARD -
o UNDERGROUND HAZARD
[2j PRODUCTS,COMPLETED .
OPERATIONS HAZARD'
[3 CONTRACTUAL INSURANCE
[3 BROAD FORM PROPe,RTY
DAMAGE ' ,-
[3 INDEPENDENT CONTRACTORS
[2g PERSONAL I~JURY
AUTOMOBilE LIABILITY
o COMPREHENSIVE
DOWNED
o HIRED
o NON,OWNED
FORM
EXCESS LIABILITY
o UMBRELLA FORM
o OTHER THAN UMBRELLA
FORM
WGRKERS' COMPENSATION
and
EMPlOYERS'lIABllITY
OTHER
" JESCI"'PTION OF OPERATlONS/LOU.'IONSNEHICLES
RE: PARKING LICENSE
BODILY INJURY
5
PROPERTY DAMAGE
5
BODILY INJURY AND
PROPERTY DAMAGE
COMBINED
51,000
5 1,000
PERSONAL INJURY,
BODIL Y INJURY
(EACH PERSON)
BODIL Y INJURY
(EACH OCCURRENCE)
PROPERTY DAMAGE
BODIL Y INJURY AND
PROPERTY DAMAGE
COMBINED
5
5
5
5
BODIL Y INJURY AND
PROPE RTY DAMAGE
COMBINED
5
5
~
EACH ACCIDENT $
OISEASE - POLICY LIMIT S
DISEASE - EACH EMPLOYEE S
STATUTORY
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8.
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fie-I ~
sJ,,-;Je.-nLo ~ ,j!>'h f
DATE ISSUED:
Cancellation: Should any of the above described policies be cancelled before the expiration date thereof. the issuing com-
pany will endeavor to mail ---3.0- days written notice to the below named certificate holder, but failure to
mail such notice shall impose no obligation or liability of any kind upon the company.
':'CORD 25 (10/85)
NAME AND ADDRESS OF CERTIFICATE HOLDER:
CITY OF CLEARWATER
P.O. BOX 4748
CLEARWATER FL 33518-4748
ATTN: DONALD J. PETERSEN, RISK MGR.
. -"" .":': - .... ,"-.