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REQUIRED COVERAGES - Where "X" Appears in Box <br /> <br />e <br /> <br />Other (Describe below) <br /> <br />.CERTIFICATES OF INSURANCE <br />Insurance Company(s) <br /> <br /> Policy Number(s) Policy Period <br /> (dates) <br /> <br />Signature of Individual author- <br />ized by Insurance Company to <br />bind Company to coverage shown, <br />and above to endorsement <br />requirements. <br /> <br />Name <br /> <br />Address <br /> <br />City, State, Zip <br /> <br />7. Self-Insurance <br /> <br /> Contractors self-insured for any risks shown in Sections above shall <br />--attach to contract evidence satisfactory to City of Contractor's financial <br /> abilty (such as a current financial statement) to respond to losses in <br /> amounts shown above, for each risk self-insured. Contractor shall <br /> complete and sign the following statement and attach to contract. <br /> <br />The Contractor is self-insured for the following coverages with respect to <br />this contract. <br /> <br />Worker's Compensation <br /> <br />Comprehensive General Liability to the limit of $ <br /> <br />x Bodily injury <br />x Property damage <br /> <br /> <br />