1-03 - Insurance Affidavit.pdf
PDF 58 KB Posted
- Attached to
- Uniforms for Police
- Solicitation number
- ITB 25-19182-YB
- 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 on ITB 25-19182-YB for Uniforms for Police. The affidavit serves as a certification that bidders have reviewed all insurance requirements contained in the bid/proposal document in consultation with their insurance agent or broker. Bidders who are awarded the contract must furnish a valid insurance certificate and endorsements meeting all specified requirements within ten (10) business days of receiving notification of award from the City. The form requires completion of contractor information including business name, address, and email, as well as contact details for the primary and secondary insurance agent or broker handling the coverage.
The affidavit is a mandatory compliance document with no pricing terms, set-asides, or funding information included. Bidders must certify their ability to meet insurance requirements prior to contract award. Any questions regarding the insurance requirements should be directed to the Director of Purchasing & Contract Management for the City of Lubbock at (806) 775-2572. The City reserves the right to reject bids and award the contract to another contractor if insurance requirements are not satisfied within the specified timeframe.
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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:
File details come from the government source that posted it. Updated .