10-02 (02) - Insurance Affidavit.pdf
PDF 93 KB Posted
- Solicitation number
- RFP 26-19455-KM
- 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 North Overton Tax Increment Finance Districts (TIF) Irrigation Improvements contract opportunity. Bidders must complete and submit this affidavit certifying that they have reviewed all insurance requirements specified in the bid/proposal document with their insurance agent or broker. The affidavit serves as the bidder's commitment that, upon notification of contract award by the City, they will provide a valid insurance certificate and all required endorsements within ten (10) business days.
The form requires submission of detailed contractor information including the bidder's signature, printed name, business name, address, and email, along with primary and secondary insurance agent/broker contact information including firm names, contact names, phone numbers, and email addresses. Failure to meet the ten business day insurance document submission deadline after award notification authorizes the City of Lubbock to reject the bid and award the contract to another contractor. Bidders with questions regarding insurance requirements should contact the City of Lubbock's Director of Purchasing & Contract Management at (806) 775-2572.
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 .