3-03 - Insurance Affidavit.pdf

This is an Insurance Affidavit form from the City of Lubbock, Texas, related to a cash farm lease bid for approximately 40 acres of tillable land located in the W/2 of Section 72, Block S, Lubbock County, Texas, near the South Water Treatment Plant Site. Bidders are required to complete and submit this affidavit certifying that they have reviewed all insurance requirements specified in the bid/proposal document with their insurance agent or broker. Contractors must affirm their ability to furnish a valid insurance certificate and endorsements meeting all stated requirements within ten business days of receiving notice of contract award from the City. The affidavit requires the bidder's original signature, printed name, business name, address, and email address, as well as contact information for the primary and secondary insurance agent or broker, including firm name, contact person, phone number, and email.

The form does not address pricing, set-asides, incumbents, or funding information. It serves solely as a certification mechanism to ensure prospective contractors possess adequate insurance coverage prior to contract execution. Bidders failing to meet the ten-business-day insurance documentation requirement may result in bid rejection and contract award to an alternative contractor. Questions regarding insurance requirements should be directed to the City of Lubbock's Director of Purchasing & Contract Management at (806) 775-2572.