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<br />INSURANCE REQUIREMENT AFFIDAVIT <br /> <br />MUST BE RETURNED AS PART OF BID <br />I TO BE COMPLETED BY APPROPRIATE INSURANCE AGENT <br /> <br />I, the undersigned agent, certify that the insurance requirements contained in this <br />bid document have been reviewed by me with the below-identified <br />vendor/contractor/consultantlengineer/architect. If the below-identified <br />vendor/contractor/consultantlengineer/architect is awarded this contract by the <br />City of Paris, I will be able, within ten (10) working days after being notified of <br />such award, to furnish a valid insurance certificate to the City meeting all of the <br />requirements contained in this bid. <br /> <br />Agent's Signature <br /> <br />Agent Name (Print or Type) <br /> <br />Name of Insurance Carrier <br /> <br />Address of Agency <br /> <br />City/State <br /> <br />Phone Number <br /> <br />Name of Vendor/Contractor/ConsultantlEngineer/Architect (Print or Type) <br /> <br />SUBSCRIBED AND SWORN TO before me this <br /> <br />day of <br /> <br />Notary Public, State of Texas <br /> <br />NOTE TO AGENT: <br /> <br />If this time requirement is not met, the City has the right to declare this vendor non-responsible <br />and award the contract to the next lowest bidder meeting the specifications. If you have any <br />questions concerning these requirements, please contact the City of Paris at (903) 785-7511. <br />