HomeMy WebLinkAboutINS CERT 2009-03-01
ALLSTATE LIENHOLDER SERVICE C}''NTER
PO BOX 660349
DALLAS, TX 75266-0349
'RECEIVED'
I JAN15m j
FINANCE DEPARTMENT
TOWN OF TIBURON
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TOWN OF TIBURON JOAN
1505 TIBURON BLVD
TIBURON CA 94920-2530
Date; 01/08/09
CERTIFICATE OF INSURANCE
ALLSTATE INSURANCE COMPANY
Northbrook,IIlinois, certifies that the following insurance is in force:
~LICYHOLDER POLICY NUMBER
RICHARD MUSALO 0 1490386409/01
& MARY MUSALO
1785 CENTRO WEST
TIBURON CA 94920-1908
The person or organization designated below is described in the policy as:
TOWN OF TIBURON JOAN
1505 TIBURON BLVD
TIBURON CA 94920-2530
EFFECTIVE DATE
OF CERTIFICATE
MARCH 1, 2009
POLICY PERIOD
MARCH 1, 2009
SEPTEMBER 1, 2009
At 12:01 AM
Standard Time
@ LIENHOLDER
(Loss Payable Clause)
X ADDITIONAL
INTERESTED P ARTY
BARBARA B CROCKETT
(415) 927-0822
AGENT
PHONE
Coverages de\signated below are afforded for each described vehicle:
BI $250,000 EA.PERS.- $500,000 EA.OCC. 1985 MBENZ
PD $100,000 EA.OCC. WDBAB33CIFA194285
Collision- $500 DED. Comprehensive- $100 DED.
BI $250,000 EA.PERS.- $500,000 EA.OCC. 2004 XB
PD $100,000 EA.OCC. JTLKT324X40140245
Collision- $500 DED. Comprehensive- $100 DED.
See reverse side for provisions concerning Loss Payable Clause and Additional Interested Party.
This Certificate of Insurance neither affirmatively nor negatively amends, extends or alters the coverage
afforded by the policy referred to above.
DI697
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The Loss' Payabl~ Clause of such policy provides:
"The company reserves the right to cancel such policy at any time as provided by its terms, but in such
case the company shall notifY the Lienholder when not less than ten days thereafter such cancellation shall
be effective as to the interest of said Lienholder therein and the company shall have the right, on like
notice, to cancel this agreement."
The Additional Interest Endorsement of such policy, in part, provides:
"".such insurance as is afforded by the policy" for automobile liability insurance listed on the reverse side
hereof applies also to the person or organization named as Additional Interested Party.
"As respects such...interest, no cancellation...and no endorsement...adversely affecting such additional
interest, shall be effective until ten (10) days following the mailing of written notice (to the person or
organization) of such cancellation or endorsement..."
580827887573P