License and Permit Bond Bond Number KNOW ALL MEN BY THESE PRESENTS, that We, (Principal’s Name) (Principal’s Address: Street, City, State, Zip and Phone) as Principal and , (Surety’s Name) a corporation organized under the laws of the State of and licensed to transact business in the State of Texas as Surety, are held and firmly bound unto the City of Irving, 825 W. Irving Boulevard, Irving, Texas 75060, as obligee, in the sum of Dollars ($50,000.00) lawful money of the United States of America, for which payment well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, THE ABOVE bounden Principal has been or is about to receive a permit or be duly licensed in Public Works restoration in compliance with all City of Irving Ordinances pertaining to Right-of-Way Management by the Obligee in accordance with the rules and regulations of the said Obligee. NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION is such, that if the said Principal shall indemnify and save harmless the Obligee from all damages or claims for damages caused by him or his agents arising out of any work done under and by virtue of such permit or license during the period from the day of , to the day of , then this obligation shall be null and void; otherwise to remain in full force and effect. This Surety may cancel this bond at any time by filing with the Obligee thirty (30) days’ written notice of its desire to be relieved of any liability. The Surety shall not be discharged from any liability already accrued under this bond, or which shall accrue hereunder before the expiration of the thirty day period. Signed, sealed and dated this day of 20 . PRINCIPAL: SURETY: Name of Company Name of Insurance Company Signature Signature Name of Representative – Title (Print) Name of Representative – Title (Print) WITNESS: ATTEST: Signature Signature IMPORTANT NOTICE AVISO IMPORTANCE To obtain information or make a complaint: Para obtener informacion o para someter una queja: You may call the Surety’s toll free telephone number for information or to make a complaint at: Usted puede llamar al numero de telefono gratis de para informacion o para someter una queja al: 1-800-782-1546 1-800-782-1546 You may also write to the Surety at: Usted tanbien puede escribir a Surety at: P.O. Box 19725 Irvine, CA 92623-9725 P.O. Box 19725 Irvine, CA 92623-9725 You may contact the Texas Department of Insurance to obtain information on companies, coverage, rights or complaints at: Puede comunicarse con el Departamento de Seguros de Texas para obtener information acerca de companias, coberturas, derechos o quejas al: 1-800-252-3439 1-800-252-3439 You may write the Texas Department of Insurance at: Puede escribir al Departmento de Seguros de Texas P.O. Box 149104 Austin, TX 78714-9104 Fax# 512-475-1771 web: http://www.tdi.state.tx.us E-mail: ConsumerProtection@tdi.state.tx.us P.O. Box 149104 Austin, TX 78714-9104 Fax# 512-475-1771 web: http://www.tdi.state.tx.us E-mail: ConsumerProtection@tdi.state.tx.us PREMIUM•OR•CLAIM•DISPUTES: Should you have a dispute concerning your premium or about a claim you should contact the Surety first. If the dispute is not resolved, you may contact the Texas Department of Insurance. DISPUTAS SOBRE PRIMAS O RECLAMOS: Si tiene una disputa concerniente a su prima o a un reclamo, debe comunicarse con el Surety primero. Si no se resuelve la disputa, puede entonces comunicarrse con el departamento (TDI). ATTACH THIS NOTICE TO YOUR POLICY: This notice is for information only and does not become a part or condition of the attached document. UNA ESTE AVISO A SU POLIZA: Este aviso es solo para proposito de informacion y no se convierte en parte o condicion del documento adjunto. Insco Insurance Services, Inc. Underwriting Manager for: Developers Surety and Indemnity Company • Indemnity Company of California 17780 Fitch, Suite 200 Irvine, CA 92614 1-800-782-1546 www.InscoDico.com ID-1404 (TX) (Rev. 7/07)