SS9901-CS060210 ' -Arch
Insurance Group'
ARCH SURETY - ATLANTA
3500 LENOX ROAD
SUITE 1400
ATLANTA, GA 30326
(404) 682-3678 FAX (404) 682-3613
Principal:
Account:
Desc:
MasTec Nodh America, Inc. - (ACCOUNT) Bond No: SU 1005465 Bond Amount:
MesTec North Amedca, Inc. - (ACCOUNT) Bond Eft. Date:
DeForest Road Lift Improvements. Fome Main Line D - Project Date:
No. SS 99-01 - Bid No. Q-t203-01 Carrier:
$2,364,835-54I
5/18/2004I
12/15/2005
Arch nsurance
Obligee:l City of Coppell
255 Parkway Blvd.
P.O. Box 9478
Coppell, TX 75019
Obligee:
Please complete and return this form, at your earliest convenience, with current job status
information. Please fax to (404) 682-3613 or mail to the address indicated below. Thank
you.
If the contract IS complete:
Date Completed
Acceptance Date
If the contract IS NOT complete:
Final Contract Price
Work Satisfactory?
Work Completed to Date
(Percent)
Amount Paid to Contractor
Anticipated Completion Date
Work Progressing
Satisfactorily?
Yes [~ No F-]
Comments:
Print Your Name
Sign at u re ~-~11'~,~
Phone No: ( ) ~ ~' ~]
¢o
Fax No:( )
Return To:
ARCH SURETY - ATLANTA
3500 LENOX ROAD
SUITE 1400
ATLANTA, GA 30326