4-03 Insurance Affidavit.pdf

This is an Insurance Affidavit form required by the City of Lubbock, Texas for bidders and offerors responding to RFP 25-19282-MA for ultrasonic water meters, products, and services. The affidavit certifies that the bidder has reviewed all insurance requirements contained in the bid/proposal document in consultation with their insurance agent or broker. Bidders must acknowledge their ability to furnish a valid insurance certificate and endorsements meeting all specified requirements within ten business days of receiving notification of contract award from the City. The form requires the original signature of the contractor representative along with printed name, contractor business name, address, and email address. Additionally, the form requests contact information for the primary and secondary insurance agent or broker, including firm name, contact name, phone number, and email address. The City of Lubbock reserves the right to reject any bid or proposal if insurance requirements are not met within the specified timeframe, with the option to award the contract to another contractor.

No pricing terms, set-asides, incumbent information, or funding details are contained within this affidavit document. The form serves solely as a certification mechanism to ensure bidders possess adequate insurance coverage before contract execution. For questions regarding insurance requirements, bidders are directed to contact the Director of Purchasing & Contract Management for the City of Lubbock at (806) 775-2572.