Usbancorp
1310 Madrid Street Suite 101
Marshall, MN 56258
Phone (507) 532-7755
Fax (800) 328-9092
LEASE # BETWEEN Worrell, LESSEE AND Usbancorp, LESSOR.
The undersigned hereby certifies that all equipment described on the lease
agreement noted above is fully protected against loss and/or liability by the self-insured
status of lessee. If a loss should occur,Usbancorp's interest will be protected fully.
However, as we are covering the equipment until receipt of this letter, any charges
incurred prior to the receipt of said letter will be due and payable. This letter needs to be
sent to the above address to my attention.
Lessee will contact Lessor in writing 10 days prior to changes in regard to self insured
status.
DATE:____________________________
LESSEE:__________________________
SIGNATURE:_______________________
TITLE:_____________________________