1-03 - Insurance Affidavit (2).pdf
PDF 165 KB Posted
- Solicitation number
- ITB 26-19356-SR
- Issued by
- Henderson County, Texas
About this file
This is an Insurance Affidavit form required by the City of Lubbock, Texas for bidders and offerors responding to the Reverse Osmosis Water Equipment for South Water Treatment solicitation (Project Number 184487-SR, GovTribe ID 26-19356-SR). The affidavit certifies that the bidder or offeror has reviewed all insurance requirements contained in the bid/proposal document in consultation with their insurance agent or broker. Upon contract award notification from the City of Lubbock, the contractor must furnish a valid insurance certificate and all required endorsements within ten (10) business days to remain eligible for contract execution.
The form requires completion by the contractor with signature, printed name, business name, address, and email address. Additionally, the contractor must provide contact information for at least one insurance agent or broker, including firm name, contact person name, phone number, and email address. Questions regarding insurance requirements should be directed to the City of Lubbock's Director of Purchasing & Contract Management at (806) 775-2572. The City reserves the right to reject any bid/proposal if insurance requirements are not satisfied within the specified timeframe and may award the contract to another contractor.
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Text version
To Be Completed by Bidder or Offeror
If the time requirement specified above is not met, the City has the right to reject this bid/proposal and award the contract to another contractor. If you have any questions concerning these requirements, please contact the Director of Purchasing & Contract Management for the City of Lubbock at (806)
775-2572.
NOTE TO CONTRACTOR
City of Lubbock
Insurance Requirement Affidavit
Project Number:
I, the undersigned Bidder/Offeror certify that the insurance requirements contained in this bid/proposal document have been reviewed by me and my Insurance Agent/Broker. If I am awarded this contract by the City of Lubbock (City), I will be able to, within ten (10) business days after being notified of such award by the City, furnish a valid insurance certificate and endorsements to the City meeting all of the requirements presented herein.
Contractor Representative (Original Signature) Contractor Representative (Printed)
Contractor’s Business Name:
(Print or Type)
Contractor’s Address:
Contractor’s Email Address:
INSURANCE AGENT/BROKER CONTACT INFORMATION
Firm Name:
Contact Name:
Phone No.: Email:
INSURANCE AGENT/BROKER CONTACT INFORMATION
Firm Name:
Contact Name:
Phone No.: Email:
184487 Typewritten Text
26-19356-SR
File details come from the government source that posted it. Updated .