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Option B <br />I elect to obtain my own commercial insurance on the equipment shown below from the following agent and <br />insurance company. I understand that the processing of this transaction may be held pending receipt and <br />verification of this information. <br />Date November 2, 2010 <br />Customer's Name Citv of San Marcos <br />Address 630 E HOPKINS <br />City SAN MARCOS State Tic Zip 78666 <br />Dealer Name HOLT TEXAS. LTD. <br />1 have entered into the above agreement under which I am responsible for providing insurance against ALL RISKS of direct physical <br />loss or damage for the actual cash value of the following equipment, subject to common exclusions such as damage caused by <br />corrosion, rust, mechanical or electrical breakdown, etc. Need a quote? Call Caterpillar Insurance Services 800- 248 -4228 <br />extension 5754 <br />Model # Equipment Description <br />Serial # <br />A RMW CatelpllimGENERATOR <br />sNN CATOOC 44PD4B01876 <br />B. 1751 W Cateipolar(jENER.ATOR <br />S/N CAT00C6 6EW61301821 <br />C. TRAILER Caterpillar TRAILER <br />I) TRAWF.R <br />Carerplllar TRAR.FR <br />Texas InterRovernmental Risk Pool <br />Insurance Agency <br />Insurance Aaetrt's, me <br />l 149194 <br />Street Address <br />Austin <br />City 512 - 491 -2300 <br />Agent's Phone Number <br />Agent's E -mail Address <br />T% 78714 -9194 <br />State 512 - 491 -2404 <br />Fax Number <br />Value Inciudine Tax <br />$33 Ou <br />S.0367 NJ <br />S7,50600 <br />S10.000.00 <br />TO CUSTOMER'S INSURANCE AGENT <br />I hereby instruct you to add Caterpillar Financial Services Corporation as a loss payee: <br />A To my existing policy number <br />, which now provides the coverage required, or <br />( I To a policy which you are authorized to issue in the name listed above which will provide the coverage required. <br />Caterpillar Financial Services Corp must be given written notice within 30 days of any cancellation or non - renewal. It is also <br />understood and agreed that a breach of the Insuring conditions by the cu tomer, or any other person shall not invalidate the <br />insurance to Caterpillar Financial Services Corporati <br />Cindy Conyers ,t M ;)I W_a i (� Z//) <br />Print Name Customer Sign a J Date <br />PROCESSING OF THIS TRANSACTION MAY BE HELD PENDING RECEIPT OF THIS INFORMATION. <br />PLEASE FORWARD A COPY OF THE CERTIFICATE OR BINDER EVIDENCING COVERAGE TO: <br />CATERPILLAR FINANCIAL SERVICES CORPORATION <br />ATTN: GLOBAL POWER FINANCE - INSURANCE <br />2120 West End Avenue <br />Nashville, TN 37203 <br />Fax #: 615- 341.8688 <br />PLEASE ATTACH A COPY OF THIS NOTICE TO PROOF OF INSURANCE <br />roan No CISCICSF -3 1OR neale Code EIJO 33140371W/37Q010 1 JI PVIfT <br />3 ?Iarii7lk[� <br />