2-03 Insurance Affidavit.pdf
PDF 112 KB Posted
- Solicitation number
- RFP 26-19575-KM
- Issued by
- Hunt County, Texas
About this file
This is an Insurance Affidavit document issued by the City of Lubbock, Texas, in connection with a consulting and broker services contract for the City's property and casualty insurance programs. The affidavit requires bidders or offerors to certify that they have reviewed the insurance requirements specified in the bid/proposal document with their insurance agent or broker. Successful bidders must furnish valid insurance certificates and endorsements meeting all specified requirements within ten (10) business days after notification of contract award. The City reserves the right to reject any bid/proposal if the time requirement for insurance documentation is not met.
The affidavit form requires bidders to provide their contractor representative signature and printed name, business name, address, and email contact information. Additionally, bidders must provide complete contact information for at least one (and optionally two) insurance agent or broker firm, including the firm name, contact person name, phone number, and email address. This documentation ensures that bidders have consulted with qualified insurance professionals and can promptly deliver required insurance coverage upon contract award. The City of Lubbock Purchasing & Contract Management Department can be reached at (806) 775-2572 for questions regarding these insurance requirements.
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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 .