3-03 - Insurance Affidavit.pdf
PDF 58 KB Posted
- Attached to
- Cash Farm Lease Abernathy Site
- Solicitation number
- ITB 25-19080-SR
- Issued by
- Hunt County, Texas
About this file
This document is an Insurance Requirement Affidavit from the City of Lubbock, designed for potential contractors bidding on a project. The form requires bidders to certify that they have reviewed the insurance requirements and can provide a valid insurance certificate and endorsements within ten (10) business days of being awarded the contract. If the time requirement is not met, the City reserves the right to reject the bid and award the contract to another contractor.
The document provides space for the contractor to enter their business details, including business name, address, and contact information, as well as space for their insurance agent or broker's contact information. Contractors are advised to contact the Director of Purchasing & Contract Management at (806) 775-2572 if they have any questions about the requirements. The form is to be completed by the bidder or offeror and requires an original signature from the contractor representative.
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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:
File details come from the government source that posted it. Updated .