Insurance Security Agreement

INSURANCE SECURITY AGREEMENT

Parties

Insured / Assignor:

Secured Party / Beneficiary of Security Interest:

Recitals

WHEREAS, Insured owns or has an interest in the insurance policy(ies) described below and desires to grant, assign and deliver to Secured Party a security interest in such policy(ies) and any proceeds, benefits and sums payable thereunder to secure the indebtedness and obligations described in this Agreement; and

NOW, THEREFORE, for good and valuable consideration, the receipt and sufficiency of which are acknowledged, Insured and Secured Party agree as follows.

Policy Details (Collateral)

Coverage and Collateral Description

The following coverages under the Policy are included as collateral (check applicable):

Liability Coverage

Property Coverage

Life Insurance Coverage

Disability / Income Replacement

Collision Coverage

Comprehensive Coverage

Other (describe):

Exclusions

The following standard exclusions apply to the Policy and are acknowledged by Insured:

War or military action

Fraud or intentional acts by Insured

Nuclear hazard

Assignment; Grant of Security Interest

Insured hereby assigns, pledges and grants to Secured Party a continuing security interest in and to the Policy, policy proceeds, all benefits, rights to receive payment, options, endorsements, return premiums and unearned premiums arising under the Policy (collectively, the Collateral), to secure payment and performance of all obligations, liabilities and indebtedness of Insured to Secured Party described as:

Principal amount of secured obligation, if applicable:

Representations and Warranties

Insured represents and warrants that: (a) Insured is the lawful owner of the Collateral free and clear of any other lien or security interest except as disclosed in this Agreement; (b) the information provided in this Agreement is true, correct and complete; (c) Insured has full authority to grant and assign the security interest set forth herein.

Insured will not take any action that would impair Secured Party's interest in the Collateral, including but not limited to, permitting cancellation, lapse, alteration of coverage or assignment of proceeds to a third party without the prior written consent of Secured Party.

Covenants

Insured shall promptly provide Secured Party with copies of any notices of cancellation, nonrenewal, premium notice, endorsements, claims notices, and any other documents affecting the Collateral.

Beneficiary Designation

Insured hereby designates Secured Party as primary loss payee and, to the extent necessary to perfect Secured Party's security interest, contingent beneficiary of policy proceeds. Additional beneficiaries listed by Insured (if any) and percentage allocation:

Default; Remedies

Upon the occurrence of an Event of Default (including failure to pay secured obligations when due, material breach of any representation or covenant, insolvency, or commencement of bankruptcy proceedings by or against Insured), Secured Party may exercise all rights and remedies provided by law and this Agreement, including taking possession of any Collateral, collecting proceeds, endorsing and depositing checks, and directing the insurer to make payments to Secured Party.

Notices

Governing Law; Miscellaneous

This Agreement shall be governed by and construed in accordance with the laws of the state of . Time is of the essence with respect to Insured's performance of obligations under this Agreement.

This Agreement constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior agreements and understandings. No amendment will be effective unless in writing and signed by both Insured and Secured Party.

Authorization to Insurer

Insured authorizes the insurer to: (a) provide Secured Party with notice of any cancellation, nonrenewal, premium notice, endorsements, claim payments and other information concerning the Policy; and (b) make payments of proceeds directly to Secured Party to the extent of the secured indebtedness. Insured further authorizes Secured Party to endorse Insured's name on checks or drafts payable under the Policy for collection and application to secured obligations.

Insured consents to the filing of any financing statement or other instrument necessary to perfect Secured Party's security interest.

Consent to insurer notification: I consent to insurer notification to Secured Party and assignment of proceeds as described above.

Indemnity; Release

Insured agrees to indemnify and hold harmless Secured Party from and against any losses, liabilities, costs, expenses and reasonable attorneys' fees arising from Insured's breach of this Agreement, misrepresentations, or failure to maintain the Policy in accordance with this Agreement.

Acknowledgment and Certification

By signing below, Insured certifies under penalty of perjury that the information provided in this Agreement is true and correct, Insured has full authority to grant the security interest set forth herein, and Insured understands that this Agreement creates a binding security interest in the Policy and its proceeds in favor of Secured Party.

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