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Fram <br />11J29/2011 09,36 9037851628 <br />11/2812011 12.02 <br />Ml7RRELL AUTO GROUP <br />NS RAN E R UIR~M NT F!p VI~' <br />TO DE CQMPLETF;D E3Y APPROARIATE !NSlJRANCE AGENT <br />M S7 E I R TU 1~,~',~ AS ~q~ Q~' rC► <br />#789 P.0021003 <br />PAGE Q2/09 <br />1, the undersigned agettt, cer#ify thaf the insurance requlr$ments contained In thf5 bjd <br />dpcUment have beell revfewad by me with the be(aw-(dentified <br />vendar/contractar/cansultan#/engirteer/architect, ff the beIowWidentiffed <br />vendor/cqCltractor/cansu}tar,Uenglneer/architect is awarded this coiitract by the Clty af <br />Paris, I will be able, wfthin tan (10) working days after being n4tified af such award, to <br />furnJsh a valid insurance certiflcate to the City meetirg aII ofthe requirtgments contained !n <br />fhis bid. <br />~ <br />~ AgenYs Sign e , <br />Agent Na (.i~rint or 1"yp ) <br />~.t,~'~c~ ti)' { <br />Name f Insurance Carrier <br />y Address of Agency <br />Phone <br />Name of V <br />'Architect (Print or Type) <br />~SUBSCRIBEb ANiJ SWC3R3V Tq before me this day of <br />~ <br />1 <br />STEipFMlE 0. HICMlQLg <br />MYCbMMiSSIqNExpIRES <br />s~r+r►~r20,20m CNo ary. bfic, State nf7exas <br />NQTE TQ AGENT: ' <br />If ihfs time requfrement is npt r'rtet, ths Clly has the rlght to declare this vendor nan-rasppnsible <br />and award the cantract to the next lowest 6idder maetlng lhe speclfiaatlans. If ynu have any <br />ques#ian5 conGernin lhsse re ulremenks, please contact the City of Parie at '903) 7e5-7511, <br />- 16~ <br />