1-03 - Insurance Affidavit.pdf
PDF 93 KB Posted
- Attached to
- Secondary Auto Body and Collision Repairs
- Solicitation number
- ITB 26-19354-YB
- Issued by
- Harris 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 Secondary Auto Body and Collision Repairs contract opportunity. Bidders must complete and submit this affidavit certifying that they have reviewed all insurance requirements specified in the bid/proposal document in consultation with their insurance agent or broker. Upon contract award notification by the City, the successful contractor must furnish a valid insurance certificate and all required endorsements within ten (10) business days. The affidavit requires the contractor to provide their business name, address, email contact information, and original signature from an authorized representative, along with contact details for their primary and secondary insurance agents or brokers.
The form serves as a pre-award compliance verification mechanism, allowing the City to confirm contractor capacity to meet insurance obligations prior to contract execution. Failure to provide required insurance documentation within the specified timeframe grants the City the right to reject the bid and award the contract to an alternative contractor. Bidders with questions regarding insurance requirements may contact the City of Lubbock Director of Purchasing & Contract Management at (806) 775-2572.
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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 .