2-03 - Insurance Affidavit.pdf
PDF 104 KB Posted
- Attached to
- Air Filter Replacement at LPSIA
- Solicitation number
- ITB 26-19197-SR
- Issued by
- Henderson County, Texas
About this file
This document is an Insurance Requirement Affidavit for the City of Lubbock, specifically associated with Invitation to Bid (ITB) Project Number 26-19197-SR. The affidavit requires a bidder/offeror to certify that they have reviewed the insurance requirements and, if awarded the contract, will provide a valid insurance certificate and endorsements within ten (10) business days of notification. The document outlines the contractor's commitment to meet the city's insurance specifications and provides space for the contractor's business information, contact details, and insurance agent/broker contact information.
The document includes a note to contractors that failure to meet the specified time requirements may result in the City of Lubbock rejecting the bid/proposal and awarding the contract to another contractor. Contractors with questions are directed to contact the Director of Purchasing & Contract Management at (806) 775-2572. The form serves as a preliminary step in the bidding process, ensuring that potential contractors are prepared to comply with the city's insurance requirements before being considered for contract award.
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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:
ITB 26-19197-SR
File details come from the government source that posted it. Updated .