2-03 - Insurance Affidavit.pdf

PDF 148 KB Posted

Attached to
Car Wash Services for Heavy Duty City Vehicles
Solicitation number
RFP 26-19376-SR
Issued by
Henderson County, Texas

About this file

This is an Insurance Affidavit document issued by the City of Lubbock, Texas for RFP 26-19376-SR regarding Car Wash Services for Heavy Duty City Vehicles. The affidavit requires bidders and offerors to certify that they have reviewed all insurance requirements contained in the bid/proposal document with their insurance agent or broker. Upon award notification by the City, contractors must furnish a valid insurance certificate and endorsements meeting all specified requirements within ten (10) business days. The document includes fields for contractor representative signature and printed name, business name, address, and email address, as well as contact information for primary and secondary insurance agents or brokers, including firm name, contact name, phone number, and email address.

The City of Lubbock reserves the right to reject any bid or proposal if the specified time requirement for insurance certificate submission is not met, with the contract potentially being awarded to another contractor. Bidders with questions regarding insurance requirements should contact the Director of Purchasing & Contract Management for the City of Lubbock at (806) 775-2572. This affidavit serves as a pre-award compliance document to ensure contractor capability to meet contractual insurance obligations prior to contract execution.

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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:

RFP 26-19376-SR

File details come from the government source that posted it. Updated .