24-84131514-ITB Government Crime Attachment H Broker Information.pdf
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- Solicitation number
- ITB-10823
- Issued by
- Leon County, Florida
About this file
This is a Broker Information form (Attachment H) for Solicitation No. 24-84131514-ITB for Government Crime Insurance from the Florida Department of Management Services. The document is a one-page form requiring insurance brokers to provide their contact and administrative information for policy administration.
The form requires brokers to provide their company name, FEIN number, and detailed contact information for two potential roles: the person responsible for administering the insurance policy if awarded (including name, title, street address, email, phone numbers, fax number, and emergency contact number) and, if different, a separate contact person responsible for answering questions about the broker's bid (requiring the same contact details). The form appears to be a standard administrative document designed to collect essential contact information from insurance brokers participating in the bid process.
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Text version
Solicitation No. 24-84131514-ITB Government Crime Insurance
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 .