1-Statement of Insurability and Quote (OPS-2142).pdf
PDF 109 KB Posted
- Solicitation number
- BEZ26-00029974
- Issued by
- Dallas County, Texas
About this file
This is a Statement of Insurability and Quote form issued by the City of Dallas Office of Procurement Services for use in response to a Request for Proposal for Pension Investment Monitoring and Advisory Services. The form requires the bidder's authorized representative to certify that they have reviewed all insurance requirements for the contract and agree to provide a valid certificate of insurance within 15 days of award notification. The bidder must also attest that insurance requirements have been communicated to their insurance agent or broker and must submit either a quote for the cost of required insurance or proof of existing coverage. Failure to meet the 15-day insurance requirement following award notification may result in rejection of the award by the City of Dallas.
The form requires concurrent certification from an authorized representative of the insurance agency or brokerage firm confirming review of the insurance requirements, provision of a quote, and confirmation that the bidder is able to obtain the required insurance coverage. All statements made by the bidder upon submission of their bid or proposal are certified as true. Questions regarding insurance requirements should be directed to the City of Dallas Risk Management Division at (214) 671-9041.
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Text version
OPS-FRM-2142 4/7/2025
Rev. 12.14.2021 Page 1 of 1
OFFICE OF PROCUREMENT SERVICES
STATEMENT OF INSURABILITY AND QUOTE
SOLICITATION INFORMATION
Business Name:
I, as the person(s) legally authorized to sign contracts for my company, hereby attest that I have reviewed the insurance requirements for this contract and agree to produce a valid certificate of insurance meeting all the insurance requirements within 15 days of award notification. If the 15-day requirement is not met, the City of Dallas has the right to reject the award.
Furthermore, I have sent the requirements to my insurance agent or broker, and I have attached a copy of the quote for the cost of the required insurance, or proof of coverage.
By submitting a bid or proposal, I certify the above statements are true.
INSURANCE INFORMATION
I, as the authorized representative of the insurance agency or brokerage firm, have reviewed the attached insurance requirements, provided a quote, and attest that the bidder or proposer listed above is able to obtain the required insurance.
Signature, name, and title of Insurance Representative:
Agency Name:
Signature Date
Printed Name Title
Questions concerning these requirements?
Please contact the City of Dallas Risk Management Division at (214) 671-9041.
File details come from the government source that posted it. Updated .