HomeMy WebLinkAboutInsurance Certificate: Thomas Giordano
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CITY OF ASHLAND Date: 0716%1>
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A'UHLAND OR 975210-1850
CERI'IF1CATE OF INSURANCE
F.FFF.CTIVR DATE.
OF CF.RTIFICATF.
:yLI:S 1'r~ l'F, INSLJRANC'I, ('OMPANI' AUGUS 1'22, 2015
Northbrook] IIInols, certifies that the following insurance is in force:
PULI('y'HUL1)1:R POLICY NUMBEIR POLICY PERIOD
THOMAS R GIORDANO 9 76 986806 08;22 AUGUST 22, 2015 At 12 01 >.ht
105A LINCOLN Sl PFI3RUAk~' 22, 2016 s 2 1r
ASHLAND OR 9720-2284
The person or organization desi'-)nated bel()Nv is described in the policy as:
CI IY OF ASHLANI)
20 F MAIN ST I.IF.NHOLDER
ASHLANI)OR 9720-1850 ( Loss Payable Clause)
ADDITIONAL
INTFRF.STRD PARTY
A61AT ROBERT N BUCKMISTER
PHONE (541)488-2> 16
Covera,les designated below are alf wded for each described vehicle:
131 ~ 100'000 FA.PERS.- `6300,000 2006 SOLSTICE
PI) S 100,000 EA.000. I 62M13331476Y 110178
Collision- ~;SOO DI-D. Comprehensive- SI00 DED.
See reverse side fur provisions concerning Loss Payable Clause and Additional Interested Party.
1'his Certilicate of Insurance neither al7iruwtively nor negatively amends, extends or alters the coverage
af7orded by the policy referred to above..
DI696
*~0000;600046' 0199210101
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 thereaffter suet 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..."
604626019921P