2-03 - Insurance Affidavit.pdf
PDF 58 KB Posted
- Solicitation number
- ITB 26-19202-YB
- Issued by
- Hunt County, Texas
About this file
The document is an Insurance Requirement Affidavit from the City of Lubbock for a contract opportunity. The affidavit requires potential contractors to certify their understanding and ability to meet the city's insurance requirements within ten (10) business days of being awarded the contract. Contractors must review the insurance requirements with their insurance agent/broker and be prepared to provide a valid insurance certificate and endorsements that meet all specified conditions.
The document provides a template for contractors to complete, including fields for the contractor's business name, address, email, and contact information, as well as space for their insurance agent/broker's details. The city reserves the right to reject the bid/proposal and award the contract to another contractor if the time requirements are not met. Contractors with questions are instructed to 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 .