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HomeMy WebLinkAboutSalomon Betancourt 11.13.2023 V2®Allstate. You're in good hands. Cl CW A02 10 11 CERTIFICATE OF INSURANCE This certificate is issued for informational purposes only. It certifies that the policies listed in this document have been issued to the Named Insured. It does not grant any rights to any party nor can it be used, in any way, to modify coverage provided by such policies. Alteration of this certificate does not change the terms, exclusions or conditions of such policies. Coverage is subject to the provisions of the policies, including any exclusions or conditions, regardless of the provisions of any other contract, such as between the certificate holder and the Named Insured. The limits shown below are the limits provided at the policy inception. Subsequent paid claims may reduce these limits. Certificate Holder: THE TOWN OF LOS ALTOS HILLS 26379 W FREMONT RD LOS ALTOS, CA USA 940222624 Named Insured: SALOMON BETANCOURT 1133 ALBERNI ST EAST PALO ALTO CA 94303-1009 Automobile Liability Insurer Name: Allstate Insurance Company Polic Number: 648811829 1 --Any Auto 2 - Owned Autos Only 3 - Owned Priv. Pass, Autos Only 4 -- Owned Autos Other Than Priv. Pass. Autos Only 5 - Owned Autos Subject to No Fault 6 - Owned Autos Subject to a Compulsory UM Law X 17 -- Specifically Described Autos 8 - Hired Autos Only 9 - Nonowned Autos Only Policy Effective Date : 03-27-2023 Policy Expiration Date: 03-27-2024 Limits of $1, 000,000 Combined Single Limit (each accident) Insurance: BI Per Person I BI Per Accident PD Per Accident Description of Operations/Locations/Vehicles/Endorsements/Special Provisions Interested Party Type: Additional Insured - All Other THIS CERTIFICATE DOES NOT GRANT ANY COVERAGE OR RIGHTS TO THE CERTIFICATE HOLDER. IF THIS CERTIFICATE INDICATES THAT THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED, THE POLICY(IES) MUST EITHER BE ENDORSED OR CONTAIN SPECIFIC LANGUAGE PROVIDING THE CERTIFICATE HOLDER WITH ADDITIONAL INSURED STATUS. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ONLY TO THE EXTENT INDICATED IN SUCH POLICY LANGUAGE OR ENDORSEMENT. Producer: HAROLD J. LORBER Authorized Representative: Date: 11-13-23 Nx :t b"1114-3 Cl CW A02 10 11 Includes copyrighted material of Insurance Services Office, Inc., with its permission Allstate Insurance Company Additional Insured Copy Page 1 of 1 ®Allstate. You're in good hands. POLICY NUMBER: 648811829 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: SALOMON BETANCOURT Endorsement Effective Date: 11-13-2023 SCHEDULE Name Of Person(s) Or Organization(s): THE TOWN OF LOS ALTOS HILLS 26379 W FREMONT RD LOS ALTOS, CA USA 940222624 Information required to complete this Schedule, if not shown above will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. BU114-3 CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Additional Insured Copy Page 1 of 1 ®Allstate. You're in good hands. BU114-3 CUSTOMER NUMBER: 1806406 HAROLD J. LORBER 467 HAMILTON AVE STE 11 PALO ALTO, CA 94301-1828 THE TOWN OF LOS ALTOS HILLS 26379 W FREMONT RD LOS ALTOS, CA 94022-2624 1 0000231 1 1 364881 1 829021 500001 0001 003 Additional Insured Copy RUN DATE: 11-13-23