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NOSURANCE REQUlREMENT AFFIDAVIT <br />I-- TO BE COMPLETED BY APPROPRIATE INSURANCE AGENT j <br />MUST BE RE7'URIVED AS PAR7" OF 81D <br />I, #he undersigned agent, certify that fhe insurance requirements contained in this bid <br />document have been reviewed by me with the belaw-identified <br />vendor/contractor/consultant/engineerlarchitect. If the below-identified <br />vendoricontractor/consultant/engineer/architect is awarded this contract by the Cify of <br />Paris, 1 will be ab i ten king days after being notifed of such award, to <br />furnish a val' ' sura ce ' c o the City meeting all of the requirements contained <br />~ <br />in this <br />Sign re Agent Name (Print or Type) <br />?Nation~ai ( an y 1~'~'F.vvo <br />Fire Ins co./Continental Ins. Co. Valle For e I3fs. Co. <br />Name of Insurance Carrier <br />P.O. Box 277 <br />Address of Agency <br />RnrkWall, TX 75087 <br />CityiState <br />972-772-7236 <br />Phone Number <br />Richard Drake Construction Company LP <br />Name of Vendor/Gontractor/Consultant/Engineer/Archltect (Print or Type) <br />r <br />SUBS i~tANP~T~►b~fow~ his. ~ ia day of ~ <br />^ h i io''~"'+64~ M1S~71 A: E3 <br />State~of T8xa8 • <br />My Comro. Exp. 08•21•2ot4 Natary Pu lic, State of 7exas <br />NOTE 70 AGENT: <br />IF this time requirement is not met, the City has the rtght to declare this vendor non- <br />responsible and award the contract to the nexf lowest bidder meeting the specifications. lf <br />you have any questions concerning fhese requirements, please contact the City of Parls at <br />(903) 785-7511. _ <br />