2015/08/05 Council Agenda Packet

INSURANCE AUTHORIZATION AND VERIFICATION Date: August 07, 2015 I Property Schedule No: 1 To: City of Everett (the "Purchaser") From: U.S. Bancorp Government Leasing and Finance, Inc. (the "Seller") 13010 SW 68th Parkway, Suite 100 Portland, OR 97223 Attn: Lisa Albrecht TO THE PURCHASER: In connection with the above -referenced Property Schedule, Seller requires proof in the form of this document, executed by both Purchaser` and Purchaser's agent, that Purchasers insurable interest in the financed property (the "Property") meets Seller's requirements as follows, with coverage including, but not limited to, fire, extended coverage, vandalism, and theft: Seller, AND ITS SUCCESSORS AND ASSIGNS, shall be covered as both ADDITIONAL INSURED and LENDER'S LOSS PAYEE with regard to all equipment financed or leased by policy holder through or from Seller. All such insurance shall contain a provision to the effect that such insurance shall not be canceled or modified without first giving written notice thereof to Seller and Purchaser at least thirty (30) days in advance of such cancellation or modification. Purchaser must carry GENERAL LIABILITY (and/or, for vehicles, Automobile Liability) in the amount of no less than $1,000,000.00 (one million dollars). Purchaser must carry PROPERTY Insurance (or, for vehicles, Physical Damage Insurance) in an amount no less than the 'Insurable Value' $1,362,903.00, with deductibles no more than $10,000.00. 'Purchaser. Please execute this form and return with your document package. Seller will fax this form to your insurance agency for endorsement. In lieu of agent endorsement, Purchaser's agency may submit insurance certificates demonstrating compliance with all requirements. If fully executed form (or Purchaser -executed form plus certificates) is not provided within 15 days, we have the right to purchase such insurance at your expense. Should you have any questions, please contact Lisa Albrecht at (303)585-4077. By signing, Purchaser authorizes the Agent named below: 1) to complete and return this form as indicated; and 2) to endorse the policy and subsequent renewals to reflect the required coverage as outlined above. TO THE AGENT: In lieu of providing a certificate, please execute this form in the space below and promptly fax it to Sewer rve as proof that Purchaser's insurance meets the above requirements. at 303-585-4732 This fully endorsed form shall se Agent hereby verifies that the above requirements have been met in regard to the Property listed below. Print Name Of Agency: By: X (Agent's Signature) Print Name: Date: X Insurable Value: 51,362,903.00 PROPER TYDES C'!PT[C:` =CRP?CPERTY SCHEDULE NO. 77