2-03 - Insurance Affidavit.pdf

PDF 58 KB Posted

Attached to
ADA Ramp Repairs and Installations
Solicitation number
RFP 25-19082-YB
Issued by
Henderson County, Texas

About this file

The document is an Insurance Requirement Affidavit from the City of Lubbock, designed for potential contractors bidding on a municipal project. The affidavit requires bidders to certify that they have reviewed the insurance requirements and can provide a valid insurance certificate with endorsements within ten (10) business days of being awarded the contract. Contractors must complete the form with their business information, contact details, and obtain verification from their insurance agent or broker.

The document emphasizes compliance with insurance specifications and provides contact information for the Director of Purchasing & Contract Management at (806) 775-2572 for any questions. If the time requirements are not met, the City reserves the right to reject the bid and award the contract to another contractor. No specific project number or detailed insurance requirements are included in this document, which appears to be a standard pre-bid certification form for municipal contracts in Lubbock, Texas.

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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 .