5-02 (02) - Insurance Affidavit.pdf
PDF 93 KB Posted
- Attached to
- Northeast Intermediate Lift Station
- Solicitation number
- RFP 25-19043-TF
- Issued by
- Henderson County, Texas
About this file
This document is an Insurance Requirement Affidavit from the City of Lubbock for a procurement process. The affidavit requires bidders or offerors to certify that they have reviewed the insurance requirements for a specific project and commit to providing a valid insurance certificate and endorsements within ten (10) business days of being awarded the contract. Contractors must complete the form with their business details, contact information, and have their insurance agent or broker confirm their ability to meet the specified insurance requirements.
The document provides contact information for the Director of Purchasing & Contract Management at (806) 775-2572 for any questions regarding the requirements. If the time requirements are not met, the City reserves the right to reject the bid/proposal and award the contract to another contractor. The form includes spaces for the contractor's signature, business name, address, email, and insurance agent/broker contact details, emphasizing the importance of comprehensive insurance coverage for the project.
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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 .