HomeMy WebLinkAboutInsurance Certificate: Candles & Williams
ILLSP'.ITF. LIF,NHOLDI'.R SF.RVI(T ('F,NTF.R
PO ROX 660349
DALLAS, LY7? 266-0.i49
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CITY OF ASHLAND PARK Date: 0~112715
340 S PIONEER ST
ASHLAND OR 97520-2729
CERTIFICATE OF INSURANCE
F.FFI;CTIVF, DATE
OF CERTIFICATE
ALLSTATE INSURANCE COMPANY JUNE 30,2015
Northbrook,Illinois, cerlifies that the fallowing insurance is in force:
POLICYHOLDER POLICY NUMBER POLICY PERIOD
IUNF;I,I,F; MC CANllLHS 0 76 550628 1130 JUNE 30, 2015 At 0.01 A.M.
AND DENISE WILLI.~ MS DECEMBER 30, 2015 s +
PO BOX 187
MEDFORD OR 97,550 i -00 i 3
The person or organization designated below is described in the policy as:
CITY OF ASHLAND PARK
340 S PIONEER S'1' LIF,NHOLDER
(boss Payable Clause)
ASHLAND OR 97520-2729 X ADDITIONAL.
1NTIiRF.S'rF.D PARTY
AGENT PIAZZA AGENCY
PHONE (541) 472-1644
Coverages designated below are afforded for each described vehicle:
131 $ 100,000 EATFRS.- 5300,000 I A.OCC. 2003 ACCORD
PD $100.000 EA.000. I HGCM665X3A085050
Collision- $S00 DED. Comprehensive- SS00 DED.
See reverse side tot 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.
D1696
*W0003 606041 2 41 691 6i 0101k
I 11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111
The Loss Payable 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 aftorded by the policy" for automobile liability insurance listed on the reverse side
hereol'applies also to the person or organization named as Additional Interested Party.
"As respects such... interest, no cancellation ...anti no endorsement... adversely affecting such additional
interest, shall be effective until ten (10) days following the mailing ol'written notice (to the person or
organization) of such cancellation or endorsement..."
6041241(191 GSP