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SAMPLE <br />INSURANCE COVERAGE DISCLOSURE <br />Oshkosh Caoital, LESSOR <br />«LesseeName», LESSEE <br />RE: INSURANCE COVERAGE REQUIREMENTS <br />1. In accordance with the Lease Schedule ("Schedule") to the Master Lease-Purchase Agreement <br />identified in the Lease Schedule ("Master Lease"), Lessee certifies that it has instructed the insurance <br />agent named below (please fill in name, address, and telephone number): <br />to issue: (check to indicate coverage) <br />a. All Risk Physical Damage Insurance on the leased Equipment evidenced by a Certificate of Insurance <br />and Long Form Loss Payable Clause naming Oshkosh Capital and/or its assigns as Loss Payee. <br />Coverage Required: Termination Value Specified <br />b. Public Liability Insurance evidenced by a Certificate of Insurance naming Oshkosh Capital and/or its <br />assigns as an Additional Insured. <br />Minimum Coverage Required: <br />$1,000,000.00 per person <br />$2,000,000.00 aggregate bodily injury liability <br />$1,000,000.00 property damage liability <br />Proof of insurance coverage will be provided to Oshkosh Capital, 155 East Broad Street, Locator 16- <br />0056, Columbus, OH 43215, prior to the time that the property is delivered to Lessee. <br />OR <br />2. Pursuant to the Master Lease, Lessee represents and warrants, in addition to other matters under the <br />Agreement, that it is lawfully self-insured for: (check to indicate coverage) <br />a. All risk, physical damage in the amount specified in 1(a) above. <br />b. Public liability for not less than the amounts specified in 1(b) above. <br />Lessee has attached a signed letter describing self-insurance. <br />LESSEE: «LesseeName» <br />By: Title: <br />