1-03 - Insurance Affidavit.pdf
PDF 58 KB Posted
- Attached to
- Granular Complex Chloride De-icer
- Solicitation number
- ITB 25-19112-YB
- Issued by
- Henderson County, Texas
About this file
This document is an Insurance Requirement Affidavit from the City of Lubbock for a contract opportunity. The form requires a bidder or offeror to certify that they have reviewed the insurance requirements and can provide a valid insurance certificate within ten (10) business days of being awarded the contract. If the time requirement is not met, the City reserves the right to reject the bid/proposal and award the contract to another contractor.
The document provides a template for contractors to complete, including spaces for the contractor's business name, address, email, and signature, as well as contact information for their insurance agent or broker. The form includes a note with contact information for the Director of Purchasing & Contract Management at (806) 775-2572 for any questions regarding the requirements. No specific project details, pricing, or contract specifics are provided in this document beyond the insurance certification process.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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:
File details come from the government source that posted it. Updated .