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Cl CW A02 10 11
CERTIFICATE F 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, regard-
less 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 94022-2624
Named Insured:
SALOMON BETANCOURT
1133 ALBERNI ST
EAST PALO ALTO CA 94303-1009
Automobile Liability
Insurer Name: Allstate Insurance Company
Polis
Number: 648811829
Authorized Representative:
1 —Any Auto
Date: 11-13-23
2 — Owned Autos Only
3 — Owned Priv. Pass. Autos On�_
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 — Non -owned 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
BI Per Accident
PD Per Accident—'
Description of Operations/Locations/Vehicies/Endorsements/SpecialProvisions
THE TOWN OF LOS ALTOS HELLS, ITS ELECTIVE AND APPOINTED OFFICERS, EMPLOYEES,
AND VOLUNTEERS ARE LISTED AS ADDITIONAL INSURED.
Interested Part T : ADDITIONAL INSURED - 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
BU114-3 CI CW A021011
Includes copyrighted material of Insurance Services Office, Inc., with its permission
Allstate Insurance Company
Certificate Copy
Page 1 of,1
QAilstate.
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
100002311136488118290209000010001002 Certiiloate Copy
RUN DATE: 11-13-23