2-03 - Insurance Affidavit.pdf

PDF 93 KB Posted

Attached to
Lawn and Landscape for Water Treatment Plants
Solicitation number
ITB 26-19542-YB
Issued by
Henderson County, Texas

About this file

This is an Insurance Affidavit form required by the City of Lubbock, Texas for the Lawn and Landscape for Water Treatment Plants competitive sealed bid solicitation. The affidavit serves as a certification document that bidders or offerors must complete to confirm they have reviewed all insurance requirements specified in the bid documents with their insurance agent or broker. Bidders certify their ability to furnish valid insurance certificates and endorsements meeting all stated requirements within ten business days of receiving contract award notification from the City. The form requires bidders to provide their original signature, printed name, business name, address, and email, along with insurance agent or broker contact information including firm name, contact person, phone number, and email address.

The document emphasizes the mandatory nature of insurance compliance, with the City of Lubbock retaining the right to reject any bid and award the contract to another contractor if insurance requirements are not satisfied within the specified ten business day timeframe. Questions regarding insurance requirements should be directed to the City of Lubbock's Director of Purchasing & Contract Management at (806) 775-2572. This affidavit is a standard compliance document that must be executed as part of the bidding process for this contract opportunity.

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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 .