3-Statement of Insurability and Quote (OPS-2142).pdf
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- Attached to
- Planning Services for Economic Impact and Mobility Studies for “Reimagining Downtown Dallas"
- Solicitation number
- BEZ26-00029120
- Issued by
- Dallas County, Texas
About this file
This is a Statement of Insurability and Quote form issued by the City of Dallas Office of Procurement Services for use in response to a solicitation for Planning Services for Economic Impact and Mobility Studies supporting the "Reimagining Downtown Dallas" initiative. The form requires bidders and proposers to attest that they have reviewed all insurance requirements for the contract and commit to providing a valid certificate of insurance meeting those requirements within 15 days of award notification. Bidders must also confirm that they have forwarded the insurance requirements to their insurance agent or broker and have attached either a quote for the cost of required insurance or proof of existing coverage. The form further requires an authorized representative from the bidder's insurance agency or brokerage firm to review the insurance requirements, provide a quote, and attest that the bidder is capable of obtaining the required insurance.
The City of Dallas reserves the right to reject an award if the certificate of insurance is not provided within the 15-day deadline following notification of award. Bidders submit the completed form and supporting insurance documentation as part of their bid or proposal package. The form serves as a certification mechanism to ensure that selected contractors can meet all insurance obligations prior to contract execution. Inquiries regarding insurance requirements should be directed to the City of Dallas Risk Management Division at (214) 671-9041.
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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 .