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INSURANCE AUTHORIZATION AND VERIFICATION Date February 10,2016 Property Schedule No 1 To City of Pleasanton (the"Lessee") From U S Bancorp Government Leasing and Finance, Inc (the "Lessor") 1310 Madrid St,Suite 100 Marshall, MN 56258 Attn Lisa Albrecht TO THE LESSEE In connection with the above-referenced Property Schedule, Lessor requires proof in the form of this document, executed by both Lessee"and Lessee's agent,that Lessee's insurable interest in the financed property(the"Property")meets Lessor's requirements as follows,with coverage including, but not limited to, fire, extended coverage,vandalism, and theft Lessor,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 Lessor 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 Lessor and Lessee at least thirty(30)days in advance of such cancellation or modification Lessee must carry GENERAL LIABILITY(and/or,for vehicles,Automobile Liability)in the amount of no less than $1,000,000 00(one million dollars) Lessee must carry PROPERTY Insurance(or,for vehicles, Physical Damage Insurance)in an amount no less than the 'Insurable Value'$321,372 15,with deductibles no more than$10,000 00 *Lessee Please execute this form and return with your document package Lessor will fax this form to your insurance agency for endorsement In lieu of agent endorsement, Lessee's agency may submit insurance certificates demonstrating compliance with all requirements If fully executed form (or Lessee-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,Lessee 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 Agency/Agent Address Phone/Fax Email Lessee City of Pleasanton By Name Title TO THE AGENT In lieu of providing a certificate,please execute this form in the space below and promptly fax it to Lessor at 303-585-4732 This fully endorsed form shall serve as proof that Lessee's insurance meets the above requirements Agent hereby verifies that the above requirements have been met in regard to the Property listed below Print Name of Agency X By X (Agent's Signature) Print Name X Date X Insurable Value $321,372 15 ATTACHED PROPERTY DESCRIPTION FOR PROPERTY SCHEDULE NO 1