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INSURANCE AUTHORIZATION AND VERIFICATION <br />Date: June 7,20i7 Property Schedule No: 1 <br />To: City of San Marcos (the "Lemsee'`) From: U.S.Bank Equipment Finance, a division ofV.S.Bank <br />National Association (the ~Leesor') <br />i310Madrid St. <br />Marshall, MN 50258 <br />TO THE LESSEE: |nconnection with the Property Schedule, Lessor requires proof inthe form ofthis <br />document, executed by both Lessee* and Lessee's agent, that Lessee's insurable interest in the financed property (the "Property") <br />meets Lessor's requirements as follows, with coverage including, but not limited to, fire, extended coverage, vandalism, and theft: <br />Lessor, AND ITS SUCCESSORS AND ASSIGNS, shall becovered amboth ADDITIONAL INSURED and LENDER'S <br />LOSS PAYEE with regard to all equipment financed or leased by policy holder through or from Lessor. All such <br />insurance shall contain a provision to the effect that such insurance shall not be canceled or modified without first <br />giving written notice thereof to Lessor and Lessee at least thirty (30) days in advance of such cancellation or <br />modification. <br />Lessee must carry GENERAL LIABILITY (and/or, for vehicles, Automobile Liability) in the amount of no less than <br />$1'O00'VVU.O0(one million dp|lae). <br />Lessee must carry PROPERTY Insurance (or, for vehicles, Physical DamageInsurance) inanamount noless than the <br />'Insurable Value' $127,451.00, with deductibles no more than $10,000.00. <br />*Lessee: Please execute this form and return with your document package. Lessor will fax this form Voyour insurance agency for <br />endorsement. In lieu of agent endorsement, Lessee's agency may submit insurance certificates demonstrating compliance with all <br />requirements, Should you have any questions, please contact Kevin Jaramillo at 303-585-4079. <br />By signing, Lessee authorizes the Agent named below: 1) to complete and return this form as indicated; and 2>hoendorse the <br />policy and subsequent renewals to reflect the required coverage as outlined above. <br />Agency/Agent: <br />TML -IRP <br />Address: <br />P.O. Box 149194 <br />Austin, TX 78714-9194 <br />Phone/Fax: <br />8 0-537-6655 <br />Email: <br />cbrunettia-tirnlimora <br />TO THE AGENT: In lieu nfproviding a certificate, please execute this form inthe space below and promptly fax dto <br />Lessor at 303-585-4931. This fully endorsed form shall serve aaproof that Lessee's insurance meets the above <br />requirements. <br />Agent hereby verifies that the above requirements have been met in regard to the Property listed below. <br />Print Name of Agency: <br />(Agent's Signature) <br />Insurable Value: $127,451.00 <br />