Telephone No ( ) - Fax No.: ( ) - E-mail Address: IN WITNESS WHEREOF, two (2) identical counterparts of this instrument, each of which shall for all purposes be deemed an original thereof, have been duly executed by the Principal and Surety above named, on the day of , 20 . Principal (Name of Principal) (Signature of Person with Authority) (Print Name) Surety (Name of Surety) (Signature of Person with Authority) (Print Name) (Name of California Agent of Surety) (Address of California Agent of Surety) (Telephone Number of California Agent of Surety) Contractor must attach a Notarial Acknowledgment for all Surety's signatures and a Power of Attorney and Certificate of Authority for Surety. The California Department of Insurance must authorize the Surety to be an admitted surety insurer. PAYMENT BOND PAYMENT BOND -- Contractor's Labor & Material Bond (100% of Contract Price) (Note: Contractors must use this form, NOT a surety company form.) KNOW ALL PERSONS BY THESE PRESENTS:
Customer Service A. PRIMARY ACCOUNT REPRESENTATIVE. Supplier will assign an Account Representative to Sourcewell for this Contract and must provide prompt notice to Sourcewell if that person is changed. The Account Representative will be responsible for: • Maintenance and management of this Contract; • Timely response to all Sourcewell and Participating Entity inquiries; and • Business reviews to Sourcewell and Participating Entities, if applicable.
Network PHARMACY is a retail, mail order or specialty pharmacy that has a contract to accept our pharmacy allowance for prescription drugs and diabetic equipment or supplies covered under this plan. NETWORK PROVIDER is a provider that has entered into a contract with us or other Blue Cross and Blue Shield plans. For pediatric dental care services, network provider is a dentist that has entered into a contract with us or participates in the Dental Coast to Coast Network. For pediatric vision hardware services, a network provider is a provider that has entered into a contract with EyeMed, our vision care service manager.