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<br /> <br />ENTRAL <br /> <br />RENfAL & LEASING LLC <br />A Subsidiary of Butler Machinery Co. <br /> <br />INSURANCE CLARIFICATION FORM <br /> <br />CUSTOMER NAME: <br /> <br />CASS COUNTY HIGHWAY DEPARTMENT <br /> <br />(5) CAT 140H MOTORGRADERS <br />SIN CCA02249, CCA02211, CCA02243, CCA02206, CCA02238 <br /> <br />Per your rental agreement on the units shown above, you are obligated to provide <br />the following: <br /> <br />LIABILITY INSURANCE: Combined coverage for bodily injury and property <br />damage shall be in an amount not less than $500,000. <br /> <br />INSURANCE RISK AND LOSS: Lessee agrees to insure unit fully against any <br />loss for which lessor requires coverage such as, fire, theft, collision, and other such <br />11azards. Coverage shall be in an amount not less than $872,650.00 <br /> <br />Failure to provide insurance is a violation to the rental agreement. <br /> <br />INSURANCE COMPANY: <br /> <br />)A'.ftIf~AI' U~#~E <br />..A;t// #Lr...l.fN <br />1Z I /...IT #~ /If <br /> <br />AGENT: <br /> <br />AGENT'S ADDRESS: <br /> <br />,g tJJL /~..SS <br />. <br /> <br />AGENT'S PHONE #: <br /> <br />~/- 2-$"7- 3~ II <br /> <br /> <br />SIGNED: <br /> <br />-'1.1\ <br />rY~ cJ) C.O-'"f1olmrY0",;.., <br />. I , <br />~ - ~I-ob <br /> <br />TITLE: <br /> <br />DATE: <br />