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<br />BID RESPONSE FORMS <br />INSURANCE <br />(3 of 5) <br /> <br />Proposer and Insurance Agent Statement: <br />We understand the insurance requirements of these specifications and the <br />evidence of insurability shall be provided prior to contract execution. If our client is <br />awarded this contract, we agree to provide the County with a thirty (30) day written <br />notice of any intent to amend, terminate, or non-renew coverage by the insuring <br />company. <br /> <br />L f/(~. <br /> <br />Signature of Bidder's Agent <br /> <br />The Somers-Pardue Agency Inc <br />Insurance Agency <br /> <br />Insurance Carrier: <br /> <br />Cincinnati Insurance Company <br /> <br />Insurance Carrier: <br /> <br />Key Ri.s,klnsurance Company <br />- ..-, <br /> <br />Name (Typed): <br /> <br />S&S Electrical Construction Company Inc <br /> <br />I-V~ <br /> <br /> <br />Wilbur SUggS <br /> <br />Bid Submitted By: <br /> <br />Signed: <br /> <br />Address: <br /> <br />PO Box 447 <br /> <br />City State/Zip: <br /> <br />Graham~ MC 2725') <br /> <br />Area Code/ Telephone #: 3<'" "7-R40R <br /> <br />(RELATED BID INSURANCE CLAUSES) <br /> <br />Indemnity and Insurance: To the extent permitted by law the successful bidder shall <br />indemnify and save harmless the County, its officers, agents, employees and assigns from <br />and against all loss, damages, expenses and liability caused by an accident or other <br />occurrence resulting in bodily injury, including death, sickness and disease to any person; <br />or damage or destruction to property, real or personal; arising directly or indirectly from <br />operations, products or services rendered or purchased under this Invitation to Bid. <br /> <br />The successful bidder further agrees to purchase and maintain the following insurance <br />coverage's during the life of this contract with an insurance company acceptable to <br />Cabarrus County authorized to do business in the State ot North Carolina as follows: <br /> <br />26 <br /> <br />v- \ e::> <br />