4-05 - Insurance Affidavit.pdf
PDF 58 KB Posted
- Attached to
- SCADA Maintenance Services for Water Operations
- Solicitation number
- RFQ 25-18981-YB
- Issued by
- Henderson County, Texas
About this file
This document is an Insurance Requirement Affidavit from the City of Lubbock for a contract bid/proposal. The form requires a contractor to certify that they have reviewed the insurance requirements and commit to providing a valid insurance certificate and endorsements within ten (10) business days of being awarded the contract. The document allows contractors to provide their business details, contact information, and their insurance agent/broker's contact information.
The affidavit includes a note that if the time requirements are not met, the City of Lubbock reserves the right to reject the bid/proposal and award the contract to another contractor. Contractors with questions are instructed to contact the Director of Purchasing & Contract Management at (806) 775-2572. While specific project details are not included, the form is designed to ensure potential contractors have appropriate insurance coverage before being awarded a municipal contract.
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Text version
To Be Completed by Bidder or Offeror
If the time requirement specified above is not met, the City has the right to reject this bid/proposal and award the contract to another contractor. If you have any questions concerning these requirements, please contact the Director of Purchasing & Contract Management for the City of Lubbock at (806)
775-2572.
NOTE TO CONTRACTOR
City of Lubbock
Insurance Requirement Affidavit
Project Number:
I, the undersigned Bidder/Offeror certify that the insurance requirements contained in this bid/proposal document have been reviewed by me and my Insurance Agent/Broker. If I am awarded this contract by the City of Lubbock (City), I will be able to, within ten (10) business days after being notified of such award by the City, furnish a valid insurance certificate and endorsements to the City meeting all of the requirements presented herein.
Contractor Representative (Original Signature) Contractor Representative (Printed)
Contractor’s Business Name:
(Print or Type)
Contractor’s Address:
Contractor’s Email Address:
INSURANCE AGENT/BROKER CONTACT INFORMATION
Firm Name:
Contact Name:
Phone No.: Email:
INSURANCE AGENT/BROKER CONTACT INFORMATION
Firm Name:
Contact Name:
Phone No.: Email:
File details come from the government source that posted it. Updated .