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41► <br />•M <br />INSURANCE COVERAGE REQUIREMENT <br />TO: Commercial & Municipal Capital, LLC <br />1304 DeSoto Ave., Ste. 304 <br />Tampa, FL 33606-3138 <br />FROM: Indian River County Board of Caunty Commissioners <br />1840 25th Street <br />Vera Beach, FL 32960 <br />RE: INSURANCE COVERAGE REQUIREMENTS (Check one) <br />1. In accordance with Section 8.03 of the Agreement, we have instructed the insurance agent <br />named below (please fill in name, address and telephone nursiber) <br />NAME : <br />ADDRESS! <br />TELEPHONE: to issue: <br />a. All Risk Physical Damage Insurance on the leased equipment evidenced by a Cenificate of <br />Insurance and Long Form Loss Pavable Clause naming Commercial & Municipal Capital, LLC and/or <br />its Assigns as Loss Payee. <br />Coverage Required: Full Replacement Value <br />b. Public Liability Insurance evidenced by a Certificate of Insurance naming Commercial & <br />Municipal Capital, LLC and/or its Assigns as an Additional Insured. <br />Minimum Coverage Required: <br />'5500,000.00 per person <br />5500,000.00 aggregate bodily injury liability <br />£100,000.00 property damage liability <br />+F 2. Pursuant to Section 8.03 of the Agreement, we are self-insured for all risk, physical damage, <br />and public liability and will provide proof of such self-insurance in letter form together with a <br />copy of the statute authorizing this form of insurance. <br />3. Proof of insurance coverage will be provided to Commercial & Municipal Capital, LLC <br />and/or its Assigns r to the time that the equipment is delivered to its, <br />By:�` <br />el Kenneth 9. acht <br />le: Chairman <br />0 <br />