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HomeMy WebLinkAboutInsurance Certificate: Kreutzer, Daryl Allstate. You're In good hands. CI 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: Named Insured: CITY OF ASHLAND DARYL KREUTZER 20 E MAIN ST 2990 FAR WEST AVE ASHLAND, OR USA 975201814 MEDFORD OR 97501-1586 'Automobile Liability Insurer Name:Allstate Insurance Company Policy Number: 048817641 X 1--Any Auto ' 2-Owned Autos Only 3-Owned Priv.Pass.Autos Only 4--Owned Autos Other Than Priv. 5-Owned Autos Subject to 6-Owned Autos Subject to a Compulsory UM Law Pass.Autos Only No Fault X 7--Specifically Described Autos 8-Hired Autos Only 9-Nonowned Autos Only Policy Effective Date: 04-21-2021 Policy Expiration Date: 04-21-2022 Limits of $2,000,000 Combined Single Limit(each accident) Insurance: BI Per Person , ` SI Per Accident PD Per Accident Description of Operations/Locations/Vehicles/Endorsements/Special Provisions • Interested Party Type: Additional Insured - Municipality 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: DAVID W MARTIN Authorized Representative: Date: 12-01-21 Includes copyrighted material of Insurance Services Office, Inc.,with its permission BU114-3 CI CW A02 10 11 Allstate Insurance Company Page 1 of 1 Additional Insured Copy (DAlistate. You're In good hands POLICY NUMBER: 048817641 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: DARYL KREUTZER Endorsement Effective Date: 12-01-2021 • SCHEDULE • Name Of Person(s) Or Organization(s): CITY' OF ASHLAND 20 E MAIN ST 'ASHLAND, OR USA 975201814 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 Al. 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. keV 13U114-3 CA 20 48 10 13 ©Insurance Services Office, Inc., 2011 Page 1 of 1 Additional Insured Copy 13)Allstate, Youte In good hands. CUSTOMER NUMBER: 195876 RUN DATE: 12-01-21 DAVID W MARTIN 21 S 7TH ST CENTRAL POINT, OR 97502 CITY OF ASHLAND - • 20 E MAIN ST ASHLAND, OR 97520-1814 • • • • BU114-3 100002112010488176410515000330001003 Additional Insured Copy