10-05 - Insurance Affidavit.pdf
PDF 152 KB Posted
- Attached to
- LPSIA Perimeter Road Rehabilitation
- Solicitation number
- ITB 26-19210-AE
- Issued by
- Henderson County, Texas
About this file
This document is an Insurance Requirement Affidavit from the City of Lubbock for Project Number ITB 26-19210-AE. The document requires a bidder or offeror to certify that they have reviewed the insurance requirements for the contract and can provide a valid insurance certificate with endorsements 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 affidavit requires the contractor to provide complete contact information, including their business name, address, email, and details of their insurance agent or broker. The document emphasizes the importance of meeting insurance requirements and provides a contact number for the Director of Purchasing & Contract Management at (806) 775-2572 for any questions regarding the requirements. No specific pricing, funding sources, or contract details are included in this document beyond the insurance certification process.
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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:
184487 Typewritten Text
ITB 26-19210-AE
File details come from the government source that posted it. Updated .