2-03 - Insurance Affidavit.pdf
PDF 58 KB Posted
- Attached to
- Splash Pad Chemicals
- Solicitation number
- ITB 26-19483-YB
- Issued by
- Harris County, Texas
About this file
This is an Insurance Affidavit form for the City of Lubbock, Texas, related to ITB 26-19483-YB for Splash Pad Chemicals. Bidders and offerors are required to complete this affidavit certifying that they have reviewed the insurance requirements specified in the bid/proposal document with their insurance agent or broker. Upon contract award notification from the City, contractors must furnish a valid insurance certificate and endorsements meeting all specified requirements within ten business days. The form requires submission of contractor information including business name, address, email, and original signature from the contractor representative, along with contact details for the primary and secondary insurance agents or brokers.
The document serves as a prerequisite compliance requirement for bid submission. Failure to meet the ten-business-day insurance documentation deadline following award notification provides grounds for the City of Lubbock to reject the bid and award the contract to an alternative contractor. Bidders seeking clarification on insurance requirements may contact the Director of Purchasing & Contract Management at (806) 775-2572.
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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 .