1-03 - Insurance Affidavit.pdf
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- Attached to
- Tires for Fleet Vehicles & Machinery
- Solicitation number
- ITB 25-19057-AE
- Issued by
- Harris County, Texas
About this file
This document is an Insurance Requirement Affidavit from the City of Lubbock for Project Number 25-19057-AE. The affidavit requires potential contractors to certify that they have reviewed the insurance requirements for the bid/proposal and can provide a valid insurance certificate and endorsements within ten (10) business days of being awarded the contract. Contractors must complete the form by providing their business name, address, contact information, and their insurance agent/broker's details.
The document emphasizes that if the time requirements are not met, the City of Lubbock reserves the right to reject the bid/proposal and award the contract to another contractor. Potential bidders with questions are instructed to contact the Director of Purchasing & Contract Management at (806) 775-2572. The form serves as a formal commitment by the contractor to meet the city's insurance requirements and provides a mechanism for verifying insurance compliance prior to contract award.
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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
25-19057-AE
File details come from the government source that posted it. Updated .