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1.11 ,j I u~.., I L ,u <br />u_iiu_jr iii.i..vuu7 <br />INSUF~ANCE REQUfREMENT AFFID,AV(T <br />`I"O BE COMPL.ETED BY APPROPRIATE INSURANCE AGENT <br />MUST BE RETURNED •nS PART OF BID <br />I, the undersigned agent, certify that the insurance requirements contained in this bid <br />document have been reviewed by me with the below-identifiPd <br />vendorlcontractor/consulta nt/engineer/architect. If the below-identified <br />vendor/contractor/consultanVengineer/architect is awarded this contract by the City of <br />Paris, I wiil be able, within ten (10) working days after being notified of such award, to <br />furnish a valid insurance cerkificate to the City rneeting ail of the requirements contained <br />in thl5 bld. ( u ance mpany will not agree to strike the wording <br />n vor " on cancellation provisions <br />~J CURTIS FENDL$Y <br />Agenk's Signat, e Agent Name (Print orType) <br />Name of Insuranc@ Carrier <br />PQTRnX 459 <br />Acldress of Agency <br />PARIS TEXAS 75461-045 <br />City/State <br />90 - ~ <br />Phone Nurnber <br />STEPHENS & SONS CONCRETE <br />Name of Vendor/Contra ctorlConsuttantlEngineer/Architect (Print or Type) <br />SUBSCRIBED AND SWORN TO before mo this day of <br />ota , tate of Texas <br />4~11 <br />N ry <br />NO7E 7"0 AGENT: <br />if this time requlrement is not rnet, the City has the rlght to dec(are this vendor non- <br />responsibie and award the contract to tho next lowest bidder meeting tho specificaElons. If <br />you have any questions concerning lhese requirements, please contact the City of Paris at <br />(903) 785-7511. <br />G.~: 0 0 0 C, 6 5 <br />