FIRST AMENDMENT TO LEASE AGREEMENT
PREMISES: 2319 Central Avenue, Alameda, CA 94501, consisting of approximately 1,850 square feet square feet
LANDLORD: CITY OF ALAMEDA, a charter city and municipal corporation TENANT: Play House, LLC., dba Directors Cut
LEASE DATE: May 8, 2018, and executed on or about February 27, 2018 (Tenant), May 8, 2018 (Landlord)
This First Amendment to the Lease Agreement ("First Amendment"), is dated as of October ___, 2023 for reference purposes only, and is entered into by and between the CITY OF ALAMEDA, a charter city and municipal corporation ("Landlord"), and Project Burger, LLC. a California corporation ("Tenant").
NOW, THEREFORE, in consideration of the foregoing, which are incorporated herein by reference, and of their mutual covenants contained herein, the parties hereby agree as follows:
1. Background.
A. Landlord and Tenant entered into that certain Lease Agreement dated May 8, 2018, for a certain premise described therein and referred to as 2319 Central Avenue, Alameda, CA 94501, consisting of approximately 1,850 square feet square feet of rentable space (the "Premises").
B. The Expiration Date of the Lease is May 31, 2028.
C. Capitalized terms used in this First Amendment without definition shall have the same meaning given to such terms in the Lease. This First Amendment shall be effective upon the last date set forth below the parties signatures.
2. Term. The term of the Lease is hereby amended to terminate on October 31, 2024, unless 1) Tenant submits a written request to Landlord by August 31, 2024, for a one-year extension of the Lease consistent with this First Amendment and 2) Landlord, in its sole and complete discretion and with four affirmative votes from its City Council, approves said extension.
Notwithstanding the foregoing, Landlord may terminate the Lease prior to October 31, 2024 or any later-extended termination pursuant to the following provisions:
A. Within six (6) months of the effective date, Tenant shall provide Landlord with a written statement providing evidence that Tenant has been able to: a) Maintain a minimum of 36 operating hours per week; b) Maintain a minimum of 6 days of service per week, c) Maintain consistent and regular service consistent with the following schedule:
Tuesday, Wednesday and Thursday open for service from 3 pm to 8 pm; Friday and Saturday open for service from 12 pm to 11 pm, and provide service from 11 am to 4 pm Exhibit 2
on Sundays; and d) Add staff to support the restaurant operations and enable the Tenant to expand the operating hours to include six (6) additional hours of service to provide for lunch hour service on at least two weekdays per week. B. If Landlord determines at six months that Tenant has failed to provide the six-month statement, failed to maintain regular and consistent operating hours, or failed to add support staff, Landlord may terminate lease and immediately begin marketing the property for a new tenant. C. Within 12 months of effective date of this amendment, Tenant shall provide a written statement providing evidence that Tenant has been able to: a) Maintain a minimum of 42 operating hours per week, and b) Maintain consistent and regular lunch service hours at least five (5) days per week and dinner service at least four (4) days per week. 3. Base Rent. Base Rent for the two-year term of this lease shall be as follows: Base Rent Months Monthly Base Rent 1-12 $5,530 13-24 (if properly exercised and approved by the City Council as set forth above) $5,690 4. Prior Outstanding Rent. Upon execution of this amendment, Tenant is relieved of all obligation to pay outstand rent for period preceding execution of this amendment. 6. Ratification; Miscellaneous. Except as modified by this Amendment, in all other respects the Lease is hereby ratified and affirmed and remains in full force and effect. This Second Amendment may be executed in one or more counterparts. 7. Electronic Signature. This Second Amendment may be signed by electronic signature and any such electronic signature shall have the same force and effect as an original signature. Without limitation, electronic signature shall include faxed versions of an original signature or electronically scanned and transmitted versions (e.g., via pdf) of an original signature. [REMAINDER OF PAGE INTENTIONALLY LEFT BLANK] IN WITNESS WHEREOF, the undersigned have executed this First Amendment as of the day and year last set forth below. LANDLORD: CITY OF ALAMEDA, a charter city and municipal corporation By: _____________________________ Jennifer Ott, City Manager Approved as to Form By: ____________________________ Len Aslanian, Assistant City Attorney Recommended for Approval By: _____________________________ Abby Thorne-Lyman, Base Reuse and Economic Development Director TENANT: Play House, a limited liability company By: _____________________________ Name: Husam Haddad Title:___________________________ Date:___________________________
09/26/20231Broker Insurance Services1615 Hill RoadSuite 21NovatoCA94947Loran [email protected] House, LLC, DBA: Director's Cut2319 Central AvenueAlameda, CA 94501Markel Insurance CompanyCL2392600427AYBOM0008660-0610/11/202310/11/20242,000,0001,000,0005,0002,000,0004,000,0004,000,000ALiquor LiabilityBOM0008660-0610/11/202310/11/2024Each Common Cause$2,000,000Aggregate$4,000,000City of Alameda, its City Council, boards, commissions, officials, employees, and volunteers, RiverRock Real Estate Group, and any other party designatedby the City (as determined in the City's sole discretion) are named as additional insured as required per written contract. *10-Day Notice of Cancellationapplies for non-payment of premium.City of Alameda c/o River Rock Real Estate Group950 West Mall Square, Rm 239AlamedaCA94501 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS.
INSURER(S) AFFORDING COVERAGEINSURER F :INSURER E :INSURER D :INSURER C :INSURER B :INSURER A :NAIC #NAME:CONTACT(A/C, No):FAXE-MAILADDRESS:PRODUCER(A/C, No, Ext):PHONEINSUREDREVISION NUMBER:CERTIFICATE NUMBER:COVERAGESIMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement onthis certificate does not confer rights to the certificate holder in lieu of such endorsement(s).THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
OTHER:(Per accident)(Ea accident)$$N / ASUBRWVDADDLINSDTHIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.$$$$PROPERTY DAMAGEBODILY INJURY (Per accident)BODILY INJURY (Per person)COMBINED SINGLE LIMITAUTOS ONLYAUTOSAUTOS ONLYNON-OWNEDSCHEDULEDOWNEDANY AUTOAUTOMOBILE LIABILITYY / NWORKERS COMPENSATIONAND EMPLOYERS' LIABILITYOFFICER/MEMBER EXCLUDED?(Mandatory in NH)DESCRIPTION OF OPERATIONS belowIf yes, describe underANY PROPRIETOR/PARTNER/EXECUTIVE$$$E.L. DISEASE - POLICY LIMITE.L. DISEASE - EA EMPLOYEEE.L. EACH ACCIDENTEROTH-STATUTEPERLIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)EXCESS LIABUMBRELLA LIAB$EACH OCCURRENCE$AGGREGATE$OCCURCLAIMS-MADEDEDRETENTION$ $PRODUCTS - COMP/OP AGG$GENERAL AGGREGATE$PERSONAL & ADV INJURY$MED EXP (Any one person)$EACH OCCURRENCEDAMAGE TO RENTED$PREMISES (Ea occurrence)COMMERCIAL GENERAL LIABILITYCLAIMS-MADEOCCURGEN'L AGGREGATE LIMIT APPLIES PER:POLICYPRO-JECTLOC
CERTIFICATE OF LIABILITY INSURANCEDATE (MM/DD/YYYY)
CANCELLATIONAUTHORIZED REPRESENTATIVEACORD 25 (2016/03)© 1988-2015 ACORD CORPORATION. All rights reserved.CERTIFICATE HOLDERThe ACORD name and logo are registered marks of ACORD
HIREDAUTOS ONLY
MBP 2033 11 16 Includes copyrighted material of Insurance Services Office, Inc.,with its permission.Page 1 of 5 BUSINESSOWNERS THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESSOWNERS SELECT ENDORSEMENT This endorsement modifies insurance provided under the following:BUSINESSOWNERS COVERAGE FORM As respects any coverage provided by this endorsement, if higher limits are provided on any other Schedule, Declarations or endorsement attached to this policy, then the limits and coverage provided by this endorsement would not apply for that coverage. SECTION I – PROPERTY SCHEDULE OF COVERAGES LIMIT OF INSURANCE TYPE OF AMENDMENT Premises Limitation 1,000 Feet Increased Distance Increased Cost Of Construction $25,000 Increased Limit Appurtenant Buildings And Structures Building Business Person Property $25,000$5,000 Coverage ExtensionCoverage Extension Valuable Papers And Records Not At Described Premises $5,000 Coverage Extension Accounts Receivable Not At Described Premises $5,000 Coverage Extension Theft Damage To Rented Property $5,000 Coverage Extension Personal Property Of Others Replacement Cost Amended Valuation SECTION II – LIABILITY SCHEDULE OF COVERAGES TYPE OF AMENDMENT Additional Insured – By Written Contract, Agreement, Permit Or Authorization Included Duties In The Event Of Occurrence, Offense, Claim Or Suit Included I.Section I - Property is amended as follows:THE AMENDMENTS AND EXTENSIONS OF COVERAGE DETAILED BELOW ARE ADDED TO THIS POLICY IF THE APPLICABLE POLICY COVERAGE IS SPECIFICALLY IDENTIFIED IN THE DECLARATIONS. THESE EXTENSIONS OF COVERAGE WILL APPLY, WHERE AVAILABLE: 1. SEPARATELY TO EACH OF YOUR PREMISES DESCRIBED IN THE DECLARATIONS; AND 2. ONLY IF THE POLICY COVERAGE(S) THAT CORRESPOND TO EACH AMENDMENT AND EXTENSION SCHEDULED ABOVE ARE SHOWN IN THE DECLARATIONS AS COVERED BY YOUR POLICY.
M IC
MBP 2033 11 16 Includes copyrighted material of Insurance Services Office, Inc.,with its permission.Page 2 of 5 We will not pay for loss or damage in any one occurrence until the amount of loss or damage exceeds the deductible. The deductible provisions do not preclude the imposition of any applicable coverage waiting period, as stated in specific coverage section of this endorsement. Unless a separate deductible amount is shown in a specific coverage section of this endorsement, we will not pay for loss or damage in any one occurrence under any coverage on this endorsement until the amount of loss or damage exceeds the lesser of the Building or Business Personal Property deductible applicable to the highest valued building on the Schedule at the covered location at the time of loss. Deductibles do not reduce the amount of insurance. A. Premises Limitation Any reference to “within 100 feet” of the described premises is amended to read “within 1,000 feet” of the described premises. B.The following replaces Paragraph 5.Additional Coverages, I.Increased Cost of Construction, (6):Increased Cost of Construction (6) The most we will pay under this Additional Coverage, for each described building insured under Section I–Property, is the limit shown in the Schedule of this endorsement. If a damaged building(s) is covered under a blanket Limit of Insurance which applies to more than one building or item of property, then the most we will pay under this Additional Coverage, for each damaged building, is the limit shown in the Schedule of this endorsement. The amount payable under this Additional Coverage is additional insurance. C.The following is added to Paragraph 5.Additional Coverages:Appurtenant Buildings And Structures When a Limit of Insurance is shown in the Declarations for Buildings or Business Personal Property at the described premises, you may extend that insurance to apply to direct physical loss of or damage to incidental appurtenant buildings or structures, or Business Personal Property located within the incidental appurtenant buildings or structures, within 1,000 feet of that described premises, caused by or resulting from a Covered Cause of Loss. Incidental appurtenant buildings or structures include: (1)Storage buildings; (2)Carports; (3)Garages; (4)Pump houses; or (5) Above ground tanks; which have not been specifically described in the Declarations. The most we will pay for loss or damage under this Additional Coverage in any occurrence is the limit shown in the Schedule of this endorsement. The amount payable under this Additional Coverage is additional insurance. D.The following changes are made to Paragraph 6.Coverage Extensions: Valuable Papers And Records The following is added to Paragraph e.(3):For “valuable papers and records” not at the described premises, the most we will pay is the limit shown in the Schedule of this endorsement, unless a higher Limit of Insurance for “valuable papers and records” is shown in the Declarations. Accounts Receivable The following is added to Paragraph f.(2):For accounts receivables not at the described premises, the most we will pay is the limit shown in the Schedule of this endorsement, unless a higher Limit of Insurance for accounts receivable is shown in the Declarations.
MBP 2033 11 16 Includes copyrighted material of Insurance Services Office, Inc.,with its permission.Page 3 of 5 E. The following is added to Paragraph 6.Coverage Extensions: Theft Damage To Rented Property When a Limit of Insurance is shown in the Declarations for Business Personal Property at the described premises, you may extend that insurance to apply to direct physical damage caused by or resulting from theft or attempted theft to: (1)That part of a building or structure you occupy, but not own, which contains Covered Property; and (2)Property within such non-owned building or structure used for maintenance or service of such non-owned building. We will not pay under this Coverage Extension for loss or damage: (1)Caused by or resulting from fire or explosion; or (2)To glass (other than glass building blocks) or to any lettering, ornamentation or burglar alarm tape on glass. This Coverage Extension applies only if you are a tenant and you are contractually obligated to insure this exposure. The most we will pay under this coverage is the limit shown in the Schedule of this endorsement. F.The following changes are made to Paragraph E.5. Loss Payment: Personal Property Of Others Loss Payment – Replacement Cost: 1. The following is added to Paragraph E.5.d.:Personal property of others at replacement cost. 2. Paragraph E.5.d.(3)(b) is deleted in its entirety. II.Section II– Liability is amended as follows: A. Additional Insured – By Written Contract, Agreement, Permit Or Authorization The following is added to Paragraph 2. of C.Who Is An Insured: Any person or organization to whom you are required by written contract, agreement, permit or authorization to provide insurance, but only if the contract, agreement, permit or authorization is in effect during the policy period shown in the Declarations and was executed prior to the "bodily injury", "property damage" or "personal and advertising injury". However: (1)The person or organization is an additional insured only to the extent you are liable due to: (a) The ownership, maintenance or use of that part of premises you own, rent, lease or occupy, subject to the following provisions: (i)This insurance does not apply to any "occurrence" which takes place after you cease to be a tenant in any premises leased to or rented to you; (ii)This insurance does not apply to structural alterations, new construction or demolition operations performed by or on behalf of the person or organization; or (iii)This insurance does not apply to negligent acts or omissions on the part of the person or organization; (b) Your ongoing operations for that additional insured, whether the work is performed by you or for you; (c) The maintenance, operation or use by you of equipment leased to you by such person or organization, subject to the following additional provisions: (i)This insurance does not apply to any "occurrence" which takes place after the equipment lease expires or you cease to lease that equipment; and (ii)This insurance does not apply to "bodily injury" or "property damage" arising out of the sole negligence of such person or organization; (d) Permits or authorizations issued by any state or political subdivision with respect to operations performed by you or on your behalf, subject to the following additional provision:
MBP 2033 11 16 Includes copyrighted material of Insurance Services Office, Inc.,with its permission.Page 4 of 5 This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for that state or municipality. (2)This insurance does not apply to "bodily injury" or "property damage" included within the "products-completed operations hazard". (3)The insurance with respect to any manager or lessor of premises leased or rented to you and shown in the Declarations does not apply to: (a) Any "occurrence" which takes place after you cease to be a tenant in that premises. (b) Structural alterations, new construction or demolition operations performed by or on behalf of the person or organization who leases to you or manages property you rent or lease. (4)A vendor is an additional insured only with respect to “bodily injury” or “property damage” arising out of “your products” which are distributed or sold in the regular course of the vendor’s business, subject to the following additional provisions: This insurance does not apply to: (a) "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; (b) Any express warranty unauthorized by you; (c) Any physical or chemical change in the product made intentionally by the vendor; (d) Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; (e) Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; (f) Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; (g) Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or (h) "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (i)The exceptions contained in Subparagraphs (d)or(f); or (ii)Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. This insurance does not apply to any person or organization from which you have acquired such products, or any ingredient, part or container entering into, accompanying or containing such products. (5)The insurance afforded to mortgagees, assignees, or receivers arising out of the ownership, maintenance or use of premises by you does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. (6)The insurance afforded to architects, engineers, or surveyors does not apply to “bodily injury”, “property damage” or “personal and advertising injury” arising out of the rendering or failure to render any professional services by or for you, including: (a) The preparing, approving, or failure to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders, designs or drawings and specifications; or (b) Supervisory, inspection, architectural or engineering activities.
MBP 2033 11 16 Includes copyrighted material of Insurance Services Office, Inc.,with its permission.Page 5 of 5 (7)A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. (8)No coverage will be provided if, in the absence of this endorsement, no liability will be imposed by law on you. Coverage will be limited to the extent of your negligence or fault according to the applicable principles of comparative fault. (9)The insurance provided to such automatic additional insureds: (a) Only applies to the extent permitted by law; and (b) Will not be broader than that which you are required by the contract or agreement to provide for such additional insureds. (10) With respect to the insurance afforded to such additional insureds, the following is added to Paragraph D. Liability And Medical Expenses Limits Of Insurance: The most we will pay on behalf of a person or organization that is an additional insured under this endorsement is the lesser of the amount of insurance: (a) Required in a written contract, written agreement or permit issued by a state or political subdivision; (b) Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. The insurance afforded to the additional insured does not increase the Limits of Insurance shown in the Declarations. B. Duties In The Event Of Occurrence, Offense, Claim Or Suit Paragraph E. Liability And Medical Expenses General Conditions, 2.Duties In The Event Of Occurrence, Offense, Claim or Suit, is amended to include the following: Your obligation to notify us as soon as practicable of an "occurrence", offense, claim or "suit" is satisfied if you send us written notice as soon as practicable after any of your "executive officers", directors, partners, insurance managers or legal representatives become aware of or should have become aware of such "occurrence", offense, claim or "suit". All other terms and conditions remain the same.
POLICY NUMBER:BUSINESSOWNERS BP 04 48 07 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.ADDITIONAL INSURED DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following:BUSINESSOWNERS COVERAGE FORMSCHEDULEName Of Additional Insured Person(s) Or Organization(s):Information required to complete this Schedule, if not shown above, will be shown in the Declarations.Section II Liabilityis amended as follows:B.With respect to the insurance afforded to theseadditional insureds, the following is added toParagraphD. Liability And Medical ExpensesLimits Of Insurance:1.Insured:3.Any person(s) or organization(s) shown in theSchedule is also an additional insured, but onlywith respect to liability for "bodily injury","property damage" or "personal and advertisinginjury" caused, in whole or in part, by your actsor omissions or the acts or omissions of thoseacting on your behalf in the performance ofyour ongoing operations or in connection withyour premises owned by or rented to you.If coverage provided to the additional insured isrequired by a contract or agreement, the most wewill pay on behalf of the additional insured is theamount of insurance:Required by the contract or agreement; or2.Available under the applicable Limits OfInsurance shown in the Declarations;This endorsement shall not increase theHowever:a.The insurance afforded to such additionalinsured only applies to the extent permittedby law; andapplicable Limits Of Insurance shown in theDeclarations. b.If coverage provided to the additionalinsured is required by a contract oragreement, the insurance afforded to suchadditional insured will not be broader thanthat which you are required by the contractor agreement to provide for such additionalinsured.BP 04 48 07 13 A.
The following is added to ParagraphC. Who Is Anwhichever is less.cInsurance Services Office, Inc., 2012 09/26/20231Broker Insurance Services1615 Hill RoadSuite [email protected] Insurance CompanyP.O. Box 2279Omaha, NE 68103-2279Play House, LLC, DBA: Director's Cut2319 Central AvenueAlameda, CA 94501BOM0008660-0610/11/202310/11/20242319 Central Ave., Alameda, CA 94501Business Personal Property - Replacement Cost Valuation$10,000$1,000Business Income - 12 Months Actual Loss Sustained"Special Form" coverage is comprehensive subject to policy exclusions such as earthquake and floodCity of Alameda c/o RiverRock Real Estate Group950 West Mall Square, Rm 239AlamedaCA94501 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BEDELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.CANCELLATION© 1993-2015 ACORD CORPORATION. All rights reserved.ACORD 27 (2016/03)The ACORD name and logo are registered marks of ACORD THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISEVIDENCE OF PROPERTY INSURANCE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN ISSUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.PROPERTY INFORMATIONLOCATION/DESCRIPTIONCOVERAGE INFORMATIONCOVERAGE / PERILS / FORMSAMOUNT OF INSURANCEDEDUCTIBLE PHONE(A/C, No, Ext):(A/C, No):FAXE-MAILADDRESS:AGENCYTHIS EVIDENCE OF PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THEADDITIONAL INTEREST NAMED BELOW. THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THECOVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THEISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE ADDITIONAL INTEREST.CUSTOMER ID #:AGENCYSUB CODE:CODE:INSUREDLOAN NUMBERPOLICY NUMBERTERMINATED IF CHECKEDCONTINUED UNTILEXPIRATION DATEEFFECTIVE DATETHIS REPLACES PRIOR EVIDENCE DATED:COMPANYDATE (MM/DD/YYYY)EVIDENCE OF PROPERTY INSURANCE REMARKS (Including Special Conditions)MORTGAGEEADDITIONAL INSUREDLOSS PAYEEADDITIONAL INTERESTNAME AND ADDRESSAUTHORIZED REPRESENTATIVELOAN #
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LENDER'S LOSS PAYABLE