2023 Attachment H Broker Information.pdf
PDF 92 KB Posted
- Attached to
- Accident and Sickness (CAMP) Insurance ITB
- Solicitation number
- ITB-03867
- Issued by
- Florida
About this file
This document is an Attachment H Broker Information form related to ITB No. 23-84131600-ITB for Accident and Sickness (CAMP) Insurance issued by the state of Florida. The form requires bidders to identify the person responsible for administering the insurance policy on their behalf if awarded the contract, including their name, title, contact information, and an emergency contact number. Bidders must also provide contact information for the person responsible for answering questions about the broker's bid, if different from the policy administrator.
The related state and local contract opportunity is for Accident and Sickness (CAMP) Insurance, with the state of Florida serving as the issuing agency. The contract term and any renewal options are not specified in the provided information.
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Text version
ITB No. 23-84131600-ITB
Accident and Sickness (CAMP) Attachment H
Broker Information
Broker:
FEIN:
Bid/Insurance Policy Administration
Please identify the person who is to be responsible for administering the Insurance Policy on your behalf if award is made and include an emergency contact phone number.
Name:
Title:
Street Address:
E-mail Address:
Phone Number(s):
Fax Number:
Emergency Number:
If the person responsible for answering questions about the Broker’s Bid is different from the person identified above, please provide the same information for the person responsible for answering questions about the Broker’s Bid.
Name:
Title:
Street Address:
E-mail Address:
Phone Number(s):
Fax Number:
File details come from the government source that posted it. Updated .