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tNSURANCE REQUIREMENT AFFIDAVIT <br />TO BE C4MPLETED BY APPROPRIATE INSURANCE AGENT ~ <br />MUST BE RETURNED AS PART OF BID <br />I, the undersigned agent, certifjr that the insurance requirements contained in this bid <br />document have been reviewed by me with the below-identified <br />vendor/contractor/consultant/engineer/architect. If the below-identified <br />vendor/contractor/consultant/engineer/architect is awarded this contract by the City of <br />Paris, I will be able, within ten (10) working days after being notified of such award, to <br />furnish a valid in urance certficate to the Ciiy meeting all of the requirements contained <br />in this bid.,, ' <br />I CURTIS FENDLEY <br />Agent's Signa e Agent Name (Print or Type) <br />GENERAL LIABILITY-ADMIR INS. EXCESS - AMERICAN INTERNATIONAL SPECIALTY <br />Name of Insurance CaRier COMMERCIAL AUTO -UNITED FIRE WORKERS COMP. - TEXAS MUTUAL <br />1705 LAMAR AVENIIE <br />Address of Agency <br />PARIS, TX. 75460 <br />Cit~/State <br />9 3-784-0836 <br />P~?VPINAR%m~Dr soNS Name of Vendor/Contractor/ConsultanUEngineer/Architect (Print or Type) <br />SUBSCRIBED AND SWORN TO before me this day of <br />L~ <br />Notary Public tate of Texas <br />NOTE TO AGENT: <br />If this time requirement is not met, the City has the right to declare this vendor non- <br />responsible and award the contract to the next lowest bidder meeting the specifications. If <br />you have any questions concerning these requirements, please contact the City of Paris at <br />(903) 785-7511. <br />.ho00U 4 ~ <br />