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CM Rodney Gould Collateral Assignment ReleaseRAFq�! �1 i 2 yo 'ryWITH Ply April 8, 2019 USAA Life Insurance Company 9800 Fredericksburg Road San Antonio, TX 78288 To Whom It May Concern: We at the City of San Rafael authorize the release of the collateral assignment of contract number J244568660 for Rodney S. Gould, Jr. The loan, which came into effect on September 1, 1996. has been satisfied. Sinrely, _1 z JIM UTZ �. City Manager y-3_�zv Gary O. Phillips, Mayor • Andrew Cuyugan McCullough, Vice Mayor • Maribeth Bushey: Councilmember • Kate Colin, Councilmember • John Gamblin, Councilmember 4 ASSIV .ENT OF LIFE INSURANCE POLICY AS COLL ERAL / A. For value received the undersigned (herein called the 'Assignor') for ourselves, our heirs, representatives, and assigns do hereby assign, transfeopd set over to City of Safi Rafael whose address is 1400 Fifth Avenue, San Ra f 9 A I CA 94915 its successors and assigns (herein called the 'Assignee"), USAA 008993013 Contract # 0899301301 issued by USAA LIFE INSURANCE COMPANY of San Antonio, Texas, (herein called the 'Insurer"), and any supplementary contracts issued in connection herewith (said policy and contracts being herein called the 'Policy') on the life of Rodney S. Gould and all claims, options, privileges, rights, title, and interest therein and thereunder, except as provided in Section C hereof, subject to all the terms and conditions of the Policy and to any and all Gens, if any, which the Insurer may now or hereafter have or obtain against the Policy by reason of any advance at any time made by the Insurer in accordance with the terms of the Policy.* i his assignment does not include any funds deposited with the Insurer for the payment of future premiums on the policy above identified unless such funds are specifically and by express language included in this assignment. It is understood and agreed that this assignment is made for the purpose of securing the payment of any and all indebtedness now or hereafter owing by the undersigned to the assignee. B. It is expressly agreed that, without detracting from the generality of the foregoing and subject to the terms of the Policy, the following specific rights are included in this assignment and pass by virtue hereof: 1. The sole right to collect from the Insurer in one sum the total net proceeds of the Policy payable by reason of the death of the Insured or the maturity of the Policy; 2. The sole right to surrender the Policy and receive the total net surrender value thereof at any time provided by the terms of the Policy and at such other times as the Insurer may allow; 3. The sole right to obtain one or more loans on the Policy, either from the Insurer or, at any time, from others, and to pledge or assign the Policy as security for such loans; 4. The sole right to collect and receive all dividends, interest, or other additions of any kind now or hereafter apportioned to the Policy, if the Policy is a participating policy, and to exercise any and all options contained in the Policy with respect thereto except as provided in Section C hereof; provided that unless and until the Assignee shall notify the Insurer in writing to the contrary such dividends, interest, or other addi- tions, if any, shall be Laid or creditel iii tlla n,aimer in effect at the date of this assignment; and 5. The sole right to exercise all nonforfeiture privileges permitted by the terms of the Policy or allowed by the Insurer and to receive all benefits and advantages derived therefrom. C. It is expressly agreed that the following specific rights, so long as the Policy has not been surrendered, are reserved and excluded from this assign- ment and do not pass by virtue hereof. 1. The right to nullify the automatic premium loan provision; 2. The right to designate and change the beneficiary; and 3. The right to elect any optional mode of settlement permitted by the Policy or allowed by the Insurer; but the reservation of these rights shall in no way impair the right of the Assignee to surrender the Policy completely with all its incidents, or impair any other right of the Assignee hereunder, and any designation or change of beneficiary or election of a mode of settlement shall be subject to this assignment and to the rights of the Assignee hereunder but only until the assignment is released by the Assignee. 4. The right to collect from the Insurer any disability benefit payable in cash that does not reduce the amount of insurance. D. The Assignee covenants and agrees with the undersigned as follows: 1. That any balance of sums received hereunder from the Insurer remaining after payment of the indebtedness secured hereby shall be paid by the Assignee to the person entitled thereto under the terms of the Policy had this assignment not been executed; 2. That the Assignee will not exercise the right to surrender the Policy or, except for the purpose of paying a premium or premiums, the right to obtain policy loans from the Insurer, until there has been default in any payment due the Assignee by the undersigned in connection with this assignment or a failure to pay any premium when due, and then not until twenty days after the Assignee shall have mailed, by first-class mail, to the undersigned at the address last supplied in writing to the Assignee, notice of intention to exercise such right; and 3. That the Assignee will upon request forward without unreasonable delay to the Insurer the Policy for endorsement of any designation or change of beneficiary or any election of an optional mode of settlement. E. The Insurer is hereby authorized to recognize the Assignee's claims to rights hereunder without investigating the reason for any action taken by the Assignee, or the existence, validity, or amount of any indebtedness secured hereby, or the existence or non-existence of any default therein, or the giving or not giving of any notice under Section D2 above or otherwise, or the application made or to be made by the Assignee of any sums paid to the Assignee. The Insurer is hereby further authorized to rely upon the sole signature of the Assignee in any request for the exercise of any rights under the Policy assigned hereby, and the sole receipt of the Assignee for any sums paid by the Insurer in accordance with the terms of this assign- ment shall fully and completely release and discharge the Insurer therefor. F. The Assignee shall be under no obligation to pay any premium or the principal of, or interest on, any loans on the Policy whether or not obtained by the Assignee, but any such amounts so raid by the Assignee from his own funds shell become a part of the Lability hereby secured, shall he due immediately, and shall draw interest at a rate fixed by the Assignee from time to time, not exceeding 6% per annum. G. At the Assignee's option and upon releasing all claim to the Policy, he may direct the Insurer to make payable to him a specified amount of the proceeds in one sum and the remainder of the proceeds to the beneficiary or beneficiaries named in the Policy in accordance with the provisions of the Policy. H. It is specifically understood and agreed that USAA LIFE INSURANCE COMPANY shall have no responsibility whatsoever for the validity or effect of this assignment and that payment by USAA LIFE INSURANCE COMPANY of any sum or sums in accordance with the terms of this assignment shall fully and completely release and discharge said Company from any and all further liability for the payment of such sum or sums. 1. The Assignor certifies that no proceeding it ikrup or insolvency is pending with respect to any of them. EXECUTED this (Qday of J , 19 S WITNESSgnur ate of Assignor) /fo3 w+ajbr•, n DDRESS OF WITNESS (Signature of Assignor) CITY STATE ZIP (Signature of Assignee) (Assignee's SSA / Tax ID#) USAA LIFE INSURANCE COMPANY 9800 Fredericksburg Road San Antonio, Texas 78288 * See attached Addendum of Assignment 06692-0695 LLL,445ST ci INDIVIDUAL ACKNOWLEDGEMENT r NANCY EURMAN a 0 , COMM. #1086576 STATE OF C /1 T L 1 F0,k IV t'4 a NOTARY PUBLIC -CALIFORNIA CI /MARIN COUNTY SS: My Comm. Expires Feb. 4, 2000 yj COUNTY OF /'1 A 2 1 n/ J On theld-k_ day of JU L L! , 19% before me personally came R 0 6� G 0k !- D to me known to be the individual described in and who executed the assignment on the reverse side hereof and acknowledged to me that he/she executed the s e hereto. My commission expires GEB , Lf , 20W OTARY PUBLIC CORPORATE ACKNOWLEDGEMENT ,. JEANNE M. LEONCINI STATE OF CALIFORNIA 0 COMM, a10865c4 T fJUTANY PURLw^-CN iF C•:r. 1 SS: ( MARIN GULN', f v COUNTY OF MARIN '1 My Comm. Expires Feu. 4, 2000 On the 26t4ay of July ,1996 , before me personally came RODNEY S. GOULD,JR; who being by me duly sworn, did depose and say that he/*X resides in that he/sft is the CTTY MANAGER of CITY OF SAN RAFAEL o ration described in and which executed the assignment on the reverse side hereof; that he/XtX knows the seal of said corporation; that the seal affixed to said assignment is such corporate seal; that it was so affixed by order of the Board of Direc- tors of said corporation, and that he/XX signed his,"Kname thereto by like order. Ij,, My commission expires yG NOTARY PUBLIC NOTE: When executed by a corporation, the corporate seal should be affixed and there should be attached to the assignment a certified copy of the re- solution of the Board of Directors authorizing the signing officer to execute and deliver the assignment in the name and on behalf of the corporation. ACCEPTANCE BY USAA LIFE INSURANCE COMPANY Assignment received and filed at the Home Office of the Insurer in San Antonio, Texas, this day of , 19 By: Title: AUTHORIZED OFFICER RELEASE OF ASSIGNMENT OF INSURANCE POLICY Whereas, by a certain assignment, dated July 26, 1996 , Policy No. 008993013, Contract No. 0899301301 issued by USAA LIFE INSURANCE COMPANY on the life of Rodney S. Gould, Jr. was transferred to City of San Rafael , the undersigned, as collateral security for indebtedness, THIS IS TO CERTIFY that the said indebtedness has been paid in full and said assignment is hereby cancelled and fully voided and the said Policy and all rights thereunder are hereby released and discharged from said assignment. WlNESS hand and seal, this F SI NA URE STATE OF day of COUNTY OF SIGNATURE 19 SubscriSM-ndworn to before the undersigned Notary Public in the aforesaid state and county this day of 19 to certify which witness r -hand nd seal of office. NOTARY PUBLIC IN AND FOR 5 e e o to o, c-" -zc� COUNTY 06692-0695 LLLA45ST A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of o ixv -; t Subscribed and sworn to (or affirmed) before me on this q day of /�kpri\ , 201A, by 3I." SGhwt z proved to me on the basis of satisfactory evidence to be the persons) who appeared before me. LINDSAY FAYE LARA COMM. #2182818 z a:Notary Public . California z Marin County Comm, Faires Feb, 10,-2021 (Seal) Signature \- ,t.x RAFq�` 1 0 yo ,TyVVITH P.�`i CONTRACT ROUTING FORM INSTRUCTIONS: Use this cover sheet to circulate all contracts for review and approval in the order shown below. TO BE COMPLETED BY INITIATING DEPARTMENT PROJECT MANAGER: Contracting Department: City Managers Office Project Manager: Lidia Que Extension: 3056 Contractor Name: Rod Gould Contractor's Contact: Rod Gould Contact's Email: rodgouldI7 a gmail.com ❑ FPPC: Check if Contractor/Consultant must file Form 700 Step RESPONSIBLE DESCRIPTION COMPLETED REVIEWER DEPARTMENT DATE Check/Initial 1 Project Manager a. Email PINS Introductory Notice to Contractor n/a 4/5/2019 b. Email contract (in Word) and attachments to City Attorney c/o Laraine.Gittens@cityofsanrafael.org ®LQ 2 City Attorney a. Review, revise, and comment on draft agreement Click here to and return to Project Manager enter a date. ❑ b. Confirm insurance requirements, create Job on Click here to PINS, send PINS insurance notice to contractor enter a date. ❑ 3 Department Director Approval of final agreement form to send to Click or tap ❑ contractor to enter a Forward three (3) originals of final agreement to date. 4 Project Manager Click here to ❑ contractor for their signature When necessary, contractor -signed agreement enter a date. 5 Project Manager ❑ N/A agendized for City Council approval * *City Council approval required for Professional Services ❑ Agreements and purchases of goods and services that exceed Or $75,000; and for Public Works Contracts that exceed $175,000 Click here to Date of City Council approval enter a date. PRINT CONTINUE ROUTING PROCESS WITH HARD COPY 6 Project Manager Forward signed original agreements to City Attorney with printed copy of this routing form 7 City Attorney Review and approve hard copy of signed City Attorney agreement 8 Review and approve insurance in PINS, and bonds (for Public Works Contracts) Agreement executed by City Council authorized 9 City Manager/ Mayor G q City Clerk official 10 Attest signatures, retains original agreement and forwards copies to Project Manager