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itNUSURANCE REQUIREMENT AFFIDAVIT <br />TO SE COMPLETED BY APPROPRIATE INSURANCE AGENT <br />MUST BE RETUR?VED AS PAR1" OF BID <br />the undersigned agent, certify that the insurance requirements contained in this bid <br />document have been reviewed by me with the belaw-identified <br />vendar/contractor/consultant/enginesr/architect. If the below-identified <br />vendorlcontractor/consultantlengineer/architect is awarded this contract by the Cify of <br />Paris, 1 will be ab i ten king days after being noti#ied of such award, to <br />furnish a val' sura the City meeting ai( nf the requirements contained <br />in this b' ~ ce ' a <br />Aggrff's Sig <br />nn y rl'ev-t-0 <br />Agent Name (Print or Type) <br />~ National Fire Ins Co /Continental Ins. Co./Va11ey Forge Iiis. Co. <br />Name of Insurance Carrier <br />P.O. Box 277 <br />Address oi Agency <br />Roc(cwall, TX 75087 <br />City/State <br />972-772-7236 <br />Phone Number <br />Richard Drake Constructian Company LP <br />Name of Vendor/Contractor/Consultant/Engineer/Architect (Print ar Type) <br />hi"s. ~day of qe,&LLO,~~ <br />SUBS b iMC~1RPlâ–º~!E18 <br />h ) iOt~~""'MISTIA <br />~U1( ~ <br />M~ ,,My Comm. &x <br />20t4 Notary Pu )ic, State of Texas <br />NOTE 7p AGENT: <br />If this time raquirement is not met, the City has the right to declare this vendor non- <br />responsible and award the contract to the next lowest bldder meeting the specif+cations. If <br />you have any questians concerning these tequiremenls, please contact the City of Parfs at <br />(903) 785-7511. 1,17 <br />