AGREEMENT TO PROVIDE INSURANCE
Exhibit 10.4
DATE AND PARTIES. The date of th1s Agreement to Provide Insurance (Agreement) is 11-07-2011. The parties and their addresses are:
| OWNER: | MACC PEl LIQUIDATING TRUST | SECURED PARTY: | FARMERS & MERCHANTS SAVINGS BANK |
| 00000 XXXXXX XXX XXXXX #A307 | 000 0XX XX XX | ||
| XXXXXXX XXXXX.XX 00000 | XXXXX XXXXXX, XX 00000 |
The pronouns “you” and “your” refer to the Secured Party. The pronouns “I,” “me” and “my” refer to each person or entity signing this Agreement as Owner.
1. LOAN, LEASE. OR CONTRACT DESCRIPTION (Loan).
| A. | Data: | 11-07-2011 | ||
| B. | Loan Number: | 300011209 | ||
| C. | Loan Amount: | 2,100.000.00 | ||
| D. | Additional Information: |
2. AGREEMENT TO PROVIDE INSURANCE. As part of my Loan, I agree to do all of the following (in addition to any requirements specified in the Lon documents).
| A. | I will Insure the Property as listed and with the coverages shown in the COVERAGES section. | |||
| B. | I will have you named on the policy, with the status listed under the STATUS section. | |||
| C. | I will arrange for the insurance company to notify you that the policy is in effect and your status has been noted. | |||
| D. | I will pay for this insurance, including any fee for this endorsement. | |||
| E. | I will keep the insurance in effect until the Property is no longer subject to your security interest. (I understand that the Property may secure debts in addition to any listed in the LOAN DESCRIPTION section.) | |||
3. DESCRIPTION OF PROPERTY. The Property subject to this Agreement is described as follows.
SA DATED 11-7-2011
4. COVERAGES. l agree to insure the Property according to the following described risks, amount of coverage, and maximum deductible allowed.
¨If checked, all coverages will be for the full replacement value of the Property.
Homeowner’s Coverage. ¨ H.O. ¨ Other(Describe) ____________________________________
Insurable Value: Deductible:
Automobile Coverages. ¨ Fire ¨ Theft ¨ Collision ¨ Comprehensive ¨ Liability ¨ Other _______________
Insurable Value: Deductible:
Property Coverage. ¨ Fire ¨ Theft ¨ Collision ¨ Comprehensive ¨ Liability ¨ Other _______________
Insurable Value: Deductible:
5. STATUS. Your status shall be listed on the 1nsurance policy as follows.
¨ Lienholder ¨ Certificate Holder ¨ Additional Insured ¨ Mortgagee ¨ Other ________________
California Real Property: Hazard Insurance exceeding the replacement value of the improvements on the property is not
required as a condition of this loan.
6. ADDITIONAL TERMS
7. INSURANCE COMPANY. The insurance policy covering the Property and the insurance company issuing the policy are as
follows:
A. Policy Number: ELL123096-11 Effective From 9/29/2011 To: 9/29/2012.
B. Insurance Company Name, Address, and Phone Number:
XL Speciality Insurance Company Contact:
100 Constitution Plaza 17th Floor Xxxxxxxxx Xxxxx
Xxxxxxxx, XX 00000 000-000-0000
8. INSURANCE AGENCY AND AGENT. The insurance agency through which I have purchased, or intend to purchase, the
required insurance is as follows.
A. Agent Name ______________________________
B. Agency Name, Address, and Phone Number:
9. SIGNATURES.
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SIGNATURES FOR OWNER(S) AND AUTHORIZATION TO INSURANCE AGENT AND COMPANY. By signing below, I agree to the terms contained in this Agreement and acknowledge receipt of a copy of this Agreement. I request the listed insurance company and agency to provide the indicated coverage and list you on the policy with the indicated status. I also request the insurance company or its authorized agent to immediately confirm that the policy is in effect by signing this form and forwarding a copy of the policy to you.
X Xxxxx X. Xxxxxxxx, President 11-15-2011
Date
X ________________________________________________ ___________________________
Date
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SIGNATURE FOR SECURED PARTY AND REQUEST FOR CONFIRMATION. Upon receipt of this Agreement, the insurance company or agency named above is requested to confirm the policy, coverages shown above.
By X /s/ Xxxxx X. Xxxxxxx ___________________________
XXXXX X. XXXXXXX, SENIOR VICE PRESIDENT Date
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SIGNATURE FOR INSURANCE COMPANY AND CONFIRMATION. By signing below, insurance company confirms the existence of the insurance coverages agreed to be provided by our insured and that you will be notified not less than 10 days before cancellation.
By X _____________________________________________ ___________________________
Date
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Please return to Secured Party at the address listed in the
