5-02 (02) - Insurance Affidavit.pdf
PDF 93 KB Posted
- Solicitation number
- RFP 25-19060-TF
- Issued by
- Harris County, Texas
About this file
This document is an Insurance Requirement Affidavit from the City of Lubbock, designed for potential contractors bidding on a city project. The form requires a bidder/offeror to certify that they have reviewed the insurance requirements and, if awarded the contract, can provide a valid insurance certificate and endorsements within ten (10) business days of notification. The document outlines the city's expectations for insurance documentation and provides space for the contractor's business information, contact details, and insurance agent/broker contact information.
The affidavit serves as a pre-qualification step in the bidding process, ensuring that potential contractors have the necessary insurance coverage to meet the city's requirements. If a contractor fails to meet the specified time requirements, the City of Lubbock reserves the right to reject the bid/proposal and award the contract to another contractor. Contractors with questions about the requirements are instructed to contact the Director of Purchasing & Contract Management at (806) 775-2572.
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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 .