3-Statement of Insurability and Quote (OPS-2142).pdf
PDF 109 KB Posted
- Attached to
- Temporary Sanitation Field Labor
- Solicitation number
- BTZ25-00028774
- Issued by
- Dallas County, Texas
About this file
This document is a Statement of Insurability and Quote form from the City of Dallas Office of Procurement Services. The form is designed for businesses bidding on city contracts to confirm their ability to meet required insurance standards. Bidders must agree to produce a valid certificate of insurance meeting all contract requirements within 15 days of award notification, with the understanding that failure to do so could result in the City of Dallas rejecting the award.
The form requires both the business representative and an insurance agency representative to attest to the insurance requirements. The business must confirm they have reviewed the insurance requirements and sent them to their insurance agent, and attach a quote or proof of coverage. The insurance representative must verify that the bidder can obtain the required insurance. For any questions about the requirements, businesses are directed to contact the City of Dallas Risk Management Division at (214) 671-9041. The form is dated for potential use in April 2025 and was last revised in December 2021.
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Text version
OPS-FRM-2142 4/7/2025
Rev. 12.14.2021 Page 1 of 1
OFFICE OF PROCUREMENT SERVICES
STATEMENT OF INSURABILITY AND QUOTE
SOLICITATION INFORMATION
Business Name:
I, as the person(s) legally authorized to sign contracts for my company, hereby attest that I have reviewed the insurance requirements for this contract and agree to produce a valid certificate of insurance meeting all the insurance requirements within 15 days of award notification. If the 15-day requirement is not met, the City of Dallas has the right to reject the award.
Furthermore, I have sent the requirements to my insurance agent or broker, and I have attached a copy of the quote for the cost of the required insurance, or proof of coverage.
By submitting a bid or proposal, I certify the above statements are true.
INSURANCE INFORMATION
I, as the authorized representative of the insurance agency or brokerage firm, have reviewed the attached insurance requirements, provided a quote, and attest that the bidder or proposer listed above is able to obtain the required insurance.
Signature, name, and title of Insurance Representative:
Agency Name:
Signature Date
Printed Name Title
Questions concerning these requirements?
Please contact the City of Dallas Risk Management Division at (214) 671-9041.
File details come from the government source that posted it. Updated .