3-Statement of Insurability and Quote (OPS-2142).pdf
PDF 109 KB Posted
- Attached to
- Eviction Advocacy Program
- Solicitation number
- BEZ26-00029663
- 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 the Eviction Advocacy Program solicitation. The form serves as an attestation document requiring bidders and proposers to confirm their ability to meet specified insurance requirements and to provide supporting documentation of insurance quotes or proof of coverage. Bidders must submit a completed form signed by an authorized representative attesting that they have reviewed insurance requirements, consulted with their insurance agent or broker, and attached a quote for the required insurance or proof of existing coverage. The Eviction Advocacy Program itself is a one-year agreement with one one-year renewal option to be administered by the City of Dallas Office of Housing and Community Empowerment, with the purpose of providing legal support and representation to Dallas residents facing eviction to prevent housing instability and homelessness.
Bidders who receive an award notification are required to produce a valid certificate of insurance meeting all specified requirements within 15 days, with the understanding that failure to meet this deadline grants the City of Dallas the right to reject the award. The form also requires authorization from an insurance representative or broker attesting that the bidder is able to obtain the required insurance. Inquiries regarding insurance requirements should be directed to the City of Dallas Risk Management Division at (214) 671-9041. The program aligns with the City's Drivers of Opportunity policy framework, focusing on Opportunity Rich Neighborhoods through Stable and Accessible Housing and Pathways to Economic Security, and services are to be provided at no cost to clients.
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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 .