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INSURANCE REQUIREMENT AFFIDAVIT <br />TO BE IIIA COMPLETED BY APPROPRIATE WSURANCEAGENT <br />MUST BE RETURNED AS PART OFBID <br />I, the undersigned agent, certify the insurance requirements contained in this bid for <br />vendor/contractor/consultant/engineer/architect. If the City of Paris awards this contract, I will be able, <br />within ten (10) working days of notification of such award, to furnish a valid insurance certificate to the <br />City, meeting all of the requirements contained in this bid. <br />" Agent's ature Ag °!t's Nam <br />Signature a (Print or Type) <br />Name �ofInsurance �'rie� W..�.....�� <br />r <br />Address of Agency <br />�'lu cs► 'rx rl <br />City/State/Zip Code <br />Phone <br />Name of Vendor/Contractor/Consultant/Engineer/Architect (Printor Type) <br />SUBSCRIBED AND SWORN TO and before me this AT' aY of _ ry&l~ , 20A�3 <br />gid)`,, ;,; <br />Notary Pub ic, State of Texas <br />Note to Agent: <br />If this time requirement is not met, the City has the right to declare this vendor non -responsible and award the <br />contract to the next lowest bidder meeting the specifications. If you have any questions concerning these <br />requirements, please contact the City of Pans at 903.784.9289. <br />