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JoM DEExE <br />Customer Responsibility for Physical Damage <br />CREDIT ".: <br />. ?????x. ' ??? aInsurance <br />CITY OF`NORTH OLMSTED OHIO DBA SPRINGVALE GOLF <br />Lessee: k ' COURSE Application number: 65511 <br />Lessee• <br />Y ?~ <br />PNy <br />•?? - ! ?.? t ? <br />'3I AL DAMAGE INSURANCE for the equipment on the attached lease will be prdvided by the agency listed below: <br />r`? ? ,???,?? '' Na Agency: 'Phon Number of Agency: <br /> <br /> <br />L4eKso <br />? <br />????,? <br />? fm? ? ,.? <br />, <br />, <br />, <br />Mai ing A dress of Agency: Fax N mber of Agency: . <br /> , r <br />I(We)-a; Zrst and understand that under the terms of my (our) Ivlaster Lease Agreement with you, I(We) must at all ti?nes keep the Goods <br />insurc?, al all risk loss, damage, or destruction for the ater of its ful l-insurable value, with Deere Credit, Inc. listed as loss payee. <br />rAI ; tct y <br />I / <br />Les e S gnature Date <br />L.essee Signature. <br />Date <br />Send to John Deere Credit with the Lease Agreement and applicable schedule(s) <br />Named Insured and Loss Payee: <br />EOUIPMENT DESCRIPTION. <br />See Attached Addendum. <br />ki- <br />'? : C011?$Ct`'D9tC?3? ' ?1?4"??lB? n:t=,rs??• <br />Insurance Company: <br />Policy #: <br />Loss Payee: Deere Credit, Inc.? <br />? Yes ? Will Be Added <br />Verified By: <br />Insured Value: <br />; FORM 540RDI-US jPW .: Application Number: 65511 <br />? ? • <br />`y <br />Deere Credit, Inc. <br />6400 NW 86T" Street <br />Johnston, IA 50131-6600 <br />I Contact Name: <br />Expiration Date: