Tacos de Los Altos-Certificate of Insurance-2013Av CERTIFICATE OF LIABILITY INSURANCE
obBS/26/20113»
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certiBcare holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the
tors and conditions of the policy, wrtain policies may require an endorsement A Statement on this certificate does not confer rights W the
certificate holder in lieu of such endomemends).
PRODUCER
NpBE: Mo Randali
MG Bandali
PIN)XE FA%
xP:
2425 Porter Street, STE 18
Mesa,
Ixsu s AFPORaxG eovERAOE
wucs
Soquel, CA. 95073
INSURER A: Montpelier
INSIAND TernsIMURERB:
de Los Altos
Farmers
159 Bridges Court
INSURER L;
Fremont, CA. 94536
INSURER D:
INSURERE:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO MICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
HISIRTYPE
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MPM04008000785
11/012012
-
11/01/2013
EACH OCCURRENCE
$ 1,000,000
PREMISES Eaauna[a
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MEDEXP(As.psm)
$$000
PERSONALSADYINJURY
$1000000
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605050224
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11/012013
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OE£CPoPIOH OF OPEMTONBI LOCATIOHB/VEHICLO (AtlaONACORO IM, ABEXbna1 Remarb SGeOub, NmOnspxeb mluhe0)
The City of Cupedino and their officers, employees, representatives, volunteers, and agents are named Additional Insured
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Cupertino City Hall
ACCORDANCE WITH THE POLICY PROVISIONS.
10300 Tone Avenue
IVE
AUTIVE 1 \ I
REPRESENTAT
Cupertino, CA. 95014
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01988-2010 ACORD CORPORATION -Al rights mewed.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD