11-Exhibits Insurance Affidavit.pdf

203 KB Posted

Attached to
Asphalt Repair Services at EMWD Facilities
Solicitation number
RFP 3888
Issued by
Riverside County, California

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This document is an Insurance Affidavit for RFP #3853, issued by EMWD (Eastern Municipal Water District). The affidavit requires a proposer/company to review and agree to the Insurance Requirements (Rev. 06/2025), committing to provide all necessary insurance policies with designated limits, full endorsements, and waiver of subrogation for the full term of the agreement. The proposer must submit insurance certificates, endorsements, and waiver of subrogation within fourteen (14) calendar days of EMWD's notification of award recommendation.

The affidavit outlines critical compliance terms, including that failure to maintain the specified coverage will be sufficient cause for contract termination. The document provides space for an authorized representative to sign, acknowledging understanding and acceptance of all insurance requirements. Proposers have the option to check a box if they do not accept the terms, in which case they must detail any exceptions, additions, deletions, or specific concerns in a separate form. The document emphasizes the importance of comprehensive insurance coverage and the potential consequences of non-compliance.

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4-Exhibits Subcontractor Information.pdf PDF
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6-Exhibits Business Information.pdf PDF
7-RFP-3888 As-Needed Asphalt Maintenance and Repairs.pdf PDF
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5-Exhibits Contractors CAL OSHA FORM.pdf PDF
10-Exhibits Submittal Check-Off List.pdf PDF
9-Exhibits Pricing Page.pdf PDF
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INSURANCE AFFIDAVIT

RFP #3853

I, (Proposer/Company) have reviewed the Insurance Requirements (Rev. 06/2025) in its entirety and agree to furnish all insurance policies with designated limits, along with full endorsements, and waiver of subrogation, as stated in this Request for Proposal for the full term of the agreement.

I hereby agree to provide copies of insurance certificates, endorsements, and waiver of subrogation within fourteen (14) calendar days of EMWD’s notification of recommendation of award.

I understand and confirm that our firm is able to provide and maintain the coverage as specified.

Failure to maintain said coverage shall be sufficient cause for contract termination and shall result in termination of the awarded contract.

I understand that by signing this document, I (Proposer/Company) agree to all terms and conditions as stated in the Insurance Requirements (Rev. 06/2025).

☐ Check here if you DO NOT accept terms and conditions as stated in the Insurance Requirements (06/2025). Detail all Exceptions in, Additions, Deletions and/or Exceptions Form.

Authorized Representative’s Signature Name Authorized Representative’s Printed Name

Company Name Date

Mailing Address Telephone

City, State, Zip Code Email

Requirements Rev 062025 in its entirety and agree to furnish all insurance policies with:
Check here if you DO NOT accept terms and conditions as stated in the Insurance: Off
Company Name:
Mailing Address:
City State Zip Code:
Authorized Representatives Printed Name:
Date_7:
Telephone:
Email_5:
Signature1_es_:signer:signature:

File details come from the government source that posted it. Updated .