CERTIFICATE OF INSURANCE (8)
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ACORD~
CERTIFICATE OF LIABILITY INSURANCE
OPID
LANE-Ol 02/25/03
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.
DATE (MM/DDNYYY)
PRODUCER
The Addis Group, Inc.
2300 Renaissance Boulevard
King of Prussia PA 19406-2772
Phone: 610-279-8550 Fax:610-279-8543
INSURED Lane Industr1es, Inc.
Lane Hospitality, Inc.
Hospita11ty Investment Assoc.
Lane Hotel Investments II, L.P
One Lane Center
1200 Shermer Road
Northbrook, IL 60062
INSURERS AFFORDING COVERAGE
INSURER A: American Zurich Insurance C
INSURER B: American Guarantee &:&: Liabi
INSURER c: St. Paul Fire and Marine
INSURER 0:
INSURER E:
NAIC#
.40142
Hi! 6247
24767
COVERAGES
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, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
LTR NSR[ TYPE OF INSURANCE POLICY NUMBER DATE (MMlDDlYY) II'~hE (MM/DDNY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE $1,000,000
f--
A ~ COMMERCIAL GENERAL LIABILITY GL06847038 03/01/03 03/01/04 PREMISES (Ea occurence) $ 500,000
" ~QLi\U\"S MAPE::~P.Q.CUR f--' ----- ---. --=----- ,----- -,- -- - -------' -'- -- MEDE><P (i\nyoQe per,;ol') $ 10,000
~ EMP BENEFITS PERSONAL & ADV INJURY $1,000,000
~ LIQUOR LIAB GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000
II n PRO- IXl LOC
POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
f-- $1,000,000
B ~ ANY AUTO BAP6847040 03/01/03 03/01/03 (Ea accident)
X ALL OWNED AUTOS BODILY INJURY
f-- $
X SCHEDULED AUTOS (Per person)
f--
X HIRED AUTOS BODILY INJURY
f-- $
~ NON-OWNED AUTOS (Per accident)
f-- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESSlUMBRELLA LIABILITY EACH OCCURRENCE $25,000,000
C ~ OCCUR D CLAIMS MADE QK09000414 03/01/03 03/01/04 AGGREGATE $25,000,000
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND X I TORY LIMITS I IUJ~-
A EMPLOYERS' LIABILITY WC06847039 03/01/03 03/01/04 $ 1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT
",' "OFFICER/MEMBER EXCLUuEul --- ---"- - ---".- ~ - - - - 1- , ,- '" -$1, OOli, 000
' E.LUISEASE""EA'EMPtUYEE
If yes. describe under E.L. DISEASE - POLICY LIMIT $1,000,000
SPECIAL PROVISIONS below
OTHER
B Automobile BAP6847040 03/01/03 03/01/04 Comp Ded: $250
Physical Damage Coll Ded: $500
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS w'~~ lli 0 Wi ~ 00
For operations and activities of the licensee DBA Holiday Inn Sun Sp
located upon the property more fully described in the license agre~
effective 10/1/96. Certificate Holder is recognized as additional iJ - 33m
CERTIFICATE HOLDER CANCELLATION ftlID. I~' :';n~'IlC: ILI\
CLEAR-l SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Clearwater DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
Real Estate Services NOTICE TO THE CERTIRCATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
ATT: Earl Barrett IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
P.O. Box 4748
Clearwater, FL 33758-4748 REPRESENTATIVES. . " ,- .A i
AUTHORIZED REP .....} ~
,
Gary W. Warren, CPCU ARM
ACORD 25 (2001/08)
@ACORDCORPORATION 1988