Laserfiche WebLink
Brady Environmental Services, Inc. <br />To: City of Paris <br />City Manager <br />PO Box 9037 <br />Paris, Texas 75461 <br />INSURANCE AFFIDAVIT <br />To Be Completed By Insurance AgentBroker and submitted with Contractor's <br />proposal forms. <br />I, the undersigned Agent/Broker, certify that the insurance requirements contained in this <br />bid document have been reviewed by me with the below identified contractor. If the <br />below identified contractor is awarded this contract by City of Paris, Paris, Texas, I will <br />be able to, within ten (10) days after being notified of such award, furnish a valid <br />insurance certificate to the City of Paris meeting all of the requirements defined in this <br />bid/proposal. <br />Agent (Signature) <br />Name of Agent/Broker: _ <br />Address of Agent/Broker: <br />City/State/Zip: <br />Agent/Broker Telephone: <br />Date: <br />Contractor's Name: <br />(Print or Type) <br />Bond Coverage Provided for (indicate all that apply): <br />Commercial General Liability <br />Worker's Compensation Insurance <br />Automobile Policy <br />Agent (Print) <br />000185 <br />