CERTIFICATE OF LIABILITY INSURANCE
ACORD~ CERTIFICATE OF LIABILITY INSURANCE OP 10 C11 DATE (MM/DDIYYYY)
LANE 01 01/13/06
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
The Addis Group, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
2500 Renaissance Blvd. Ste 100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
King of Prussia PA 19406-2772
Phone: 610-279-8550 Fax: 610-279-8543 INSURERS AFFORDING COVERAGE NAIC#
INSURED Lane Industries, Inc. INSURER A: American Zurich Insurance Co. 40142
Lane Hospitality, Inc. Assoc. 26247
Hospital~ty Investment INSURER B American Guarantee & Liability
Lane Hotel Investments II, L.P INSURER c:
One Lane Center
1200 Shermer Road INSURER 0:
Northbrook, IL 60062
INSURER E:
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 IMMID DATE MMlDDJYY\ LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
-
A X COMMERCIAL GENERAL LIABILITY GL06847039 03/01/06 03/01/07 PREMISES (Ea occurence) $ 500,000
I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 10,000
- -- -- -x. tBMP--BENEFPl'S -----._~- " -- ... -"--.- '-." PERSONAL & ADV II.JURY s-r---,eoo--,ootr- -.. _.'
-
~ LIQUOR LIAB GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000
I .nPRO. !Xl LOC
POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $ 1,000,000
B X ANY AUTO BAP6847041 03/01/06 03/01/07 (Ea accident)
-
X ALL OWNED AUTOS BODILY INJURY
- $
X SCHEDULED AUTOS (Per person)
-
X HIRED AUTOS BODILY INJURY
- $
X NON-OWNED AUTOS (Per accident)
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
~ ANY AUTO OTHER THAN EAACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $25,000,000
A ~ OCCUR D CLAIMS MADE AUC930949803 03/01/06 03/01/07 AGGREGATE $25,000,000
$
~ DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND X 1 TORY L1Mmi T IUJ~-
A EMPLOYERS' LIABILITY WC06847040 03/01/06 03/01/07 $ 1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE E:L EACH ACCIDENT
_ OF.fICFR/MEMBERCUClUDE.O.L...-_____ --~--- - -~._~.~ f---- --_.---- --- ~ - -. - ~,~_.~- -EA-EMf" rw~~ . 1 ,0-00,-000 . 11
~~~~litS~~v':s?O~S below E: L DISEASE - POLICY LIMIT $ 1,000,000
OTHER
B Automobile BAP6847041 03/01/06 03/01/07 Comp Oed: $250
Physical Damage ColI Oed: $500
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
For operations and activities of the licensee DBA Holiday Inn Sun Spree
located upon the property more fully described in the license agreement
effective 10/1/96. Certificate Holder is recognized as additional insured.
CERTIFICATE HOLDER
CANCELLATION
CLEAR-1 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 CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
ATT: Earl Barrett
P.O. Box 4748 IMPOSE NO OBLIGATION OR UABlLlTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Clearwater, FL 33758-4748 REPRESENTATIVES.
A~~EN~~ c-J~
ACORD 25 (2001/08)
@ ACORD CORPORATION 1988