2-03 - Insurance Affidavit.pdf
PDF 104 KB Posted
- Solicitation number
- ITB 26-19261-SR
- Issued by
- Hunt County, Texas
About this file
This document is an Insurance Requirement Affidavit from the City of Lubbock for Invitation to Bid (ITB) Project Number 26-19261-SR. The affidavit requires bidders or offerors 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 obligation to confirm insurance compliance, with space provided for the contractor's representative to sign and provide business details, as well as contact information for their insurance agent or broker. The City of Lubbock reserves the right to reject the bid and award the contract to another contractor if the time requirements are not met, and provides a contact number for the Director of Purchasing & Contract Management for any questions regarding the 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:
ITB 26-19261-SR
File details come from the government source that posted it. Updated .