8I Consent Calendar 2016 0718 - Laserfiche WebLink

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EXHIBIT F FORM OF SELF INSURANCE CERTIFICATE Bank of America, National Association 11333 McCormick Road Mail Code: MD5-032-07-05 Hunt Valley, MD 21031 Attn: Contract Administration Re: Equipment Lease/Purchase Agreement, dated as of July 21, 2016 (the “Agreement”) between Bank of America, National Association, as Lessor, and the City of San Leandro, California, as Lessee In connection with the above-referenced Agreement, the City of San Leandro, California (the “Lessee”), the Lessee warrants and represents to Bank of America, National Association the following information. The terms capitalized herein but not defined herein shall have the meanings assigned to them in the Agreement. 1. The Lessee is self-insured for damage or destruction to the Equipment. The dollar amount limit for property damage to the Equipment under such self-insurance program is $____________. [The Lessee maintains an umbrella insurance policy for claims in excess of Lessee’s self-insurance limits for property damage to the Equipment which policy has a dollar limit for property damage to the Equipment under such policy of $____________.] 2. The Lessee is self-insured for liability for injury or death of any person or damage or loss of property arising out of or relating to the condition or operation of the Equipment. The dollar limit for such liability claims under the Lessee’s self-insurance program is $____________. [The Lessee maintains an umbrella insurance policy for claims in excess of Lessee’s self-insurance limits for liability which policy has a dollar limit for liabilities for injury and death to persons as well as damage or loss of property arising out of or relating to the condition or operation of the Equipment in the amount of $____________. [3]. The Lessee maintains a self-insurance fund. Monies in the self-insurance fund [are/are not] subject to annual appropriation. The total amount maintained in the self-insurance fund to cover Lessee’s self-insurance liabilities is $____________. [Amounts paid from the Lessee’s self-insurance fund are subject to a dollar per claim of $____________.] [3]. The Lessee does not maintain a self-insurance fund. The Lessee obtains funds to pay claims for which it has self-insured from the following sources: ______________________. Amounts payable for claims from the such sources are limited as follows: _________________. 4. Attached hereto are copies of certificates of insurance with respect to policies maintained by Lessee. 205