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CM: <br /> Financial <br /> Verification of Insurance <br /> Lessee: <br /> LESSOR(we) LESSEE(you) <br /> CATERPILLAR FINANCIAL SERVICES CORPORATION CITY <br /> CAJON REDLANDS <br /> 2120 West End Avenue 35 <br /> ST <br /> Nashville, TN 37203-0001 REDLANDS, CA 92373-4786 <br /> Subject: Insurance Coverage Requirements <br /> 1 The above-named Lessor and Lessee have entered into Governmental Equipment Lease-Purchase Agreement Transaction <br /> Number 3893399(the"Agreement') In accordance lwiith the Agreement, Lessee has` instructedA the insurance agent named below <br /> Company:Pt 1Ii MNT l iSu f`CtJt�G 3 -sf IM 1 V P5 <br /> Address'0'130)( S413 P S DENk Cat 91109 - 8113 <br /> Phone No 9 `(� ` 5 - 0 2:1 <br /> Agents Name. P IL 4'`�N T X <br /> to issue <br /> a All Risk Physical Damage Insurance on the Equipment(as defined in the Agreement)evidenced by a Certificate of Insurance and <br /> Long Form Loss Payable Clause naming the Lessor and/or its Assignee, as loss payee <br /> The Coverage Required the aggregate purchase price for the Equipment <br /> b Public Liability Insurance evidenced by a Certificate of Insurance, naming the Lessor and/or its Assignee as Additional Insured, <br /> with a minimum of$1,000,000 per occurrence is required. <br /> 2 Proof of insurance coverage will be provided to Lessor or its Assignee prior to the time the Equipment is delivered to Lessee <br /> Model# Equipment Description Serial# VIN# Value Including Tax <br /> 1 420F2 Caterpillar Backhoe Loader $127 023.00 <br /> SIGNATURES <br /> LESSEE <br /> CITY OF RE ND <br /> Signature n- ,� i <br /> Name(print) ?N , <br /> UL Yv ' FO T <br /> Title \O <br /> Date —if / ..,c) <br /> 6.5658110YR:7,m 137 PM CT <br /> Form W_GdJ1N5 <br /> IIII 111f0, III I <br />