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<br />INSURANCE COVERAGE DISCLOSURE <br /> <br />Banc One Leasinq Corporation, LESSOR <br /> <br />Citv of San Marcos. (TXl, LESSEE <br /> <br />RE: INSURANCE COVERAGE REQUIREMENTS <br /> <br />1. In accordance with the Lease/Purchase Agreement, lessee certifies that it has instructed the insurance agent <br />named below (please fill in name, address, and telephone number): <br /> <br />to issue: (check to indicate coverage) <br /> <br />_a. All Risk Physical Damage Insurance on the leased Equipment evidenced by a Certificate of Insurance and <br />Long Form Loss Payable Clause naming Bane One Leasing Corporation andlor its assigns as Loss Payee. <br /> <br />Coverage Required: Termination Value Specified <br /> <br />_b, Public Liability Insurance evidenced by a Certificate of Insurance naming <br />Bane One Leasing Corporation andlor its assigns as an Additional Insured. <br /> <br />Minimum Coverage Required: <br />$500,000.00 per person <br />$1,000,000.00 aggregate bodily injury liability <br />$500,000.00 property damage liability <br /> <br />Proof of insurance coverage will be provided to Banc One Leasing Corporation, 1111 Polaris Parkway, Suite A3, <br />Columbus, OH 43240, prior to the time that the property is delivered to Lessee. <br /> <br />OR <br /> <br />2. Pursuant to the Lease/Purchase Agreemen~ Lessee represents and warrants, in addition to other matters under <br />the Agreement, that it is lawfully self-insured for: (check to indicate coverage) <br /> <br />_a. All risk, physical damage in the amount specified in 1 (a) above. <br /> <br />_b. Public liability for not less than the amounts specified in 1 (b) above. <br /> <br />Lessee has attached a copy of the statute authorizing this form of insurance. <br /> <br />LESSEE: <br /> <br />City of San Marcos, (TX) <br /> <br />By: <br /> <br />Title: <br />