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19315(Rev.08-2013) Page 2 of 2 <br /> Contractor Name Project Numbers SC-0957(061),SC-0946(063)& <br /> MARK SAND&GRAVEL COMPANY SU-8-984(149)152 <br /> INSURANCE CERTIFICATION <br /> Certificates of Insurance contain additional pages or language on the certificate which either purports to limit or qualify <br /> the information reflected on the certificate of insurance or which purports to change,modify or amend your company's <br /> insurance policies. NDDOT policy is to not solicit,review or approve contractors'insurance policies,endorsements or <br /> amendments to insurance policies,or insurance documents other than properly completed certificates of insurance. <br /> NDDOT contacts specify that contractors are responsible for acquiring and maintaining specified coverage and proof of <br /> insurance. <br /> Please sign and date the statement below attesting that your company has insurance coverage consistent with the <br /> contract provisions. <br /> The contractor has,and will maintain in force,insurance coverage(including proof of coverage consistent with <br /> the contract specifications). <br /> CONTRACTOR: `''"" <br /> CNAO.NAME AND TITLE(TYPE OR PRINT) <br /> SIGNATURE <br /> DATE <br />