5-02 (02) - Insurance Affidavit.pdf
PDF 93 KB Posted
- Attached to
- 34th Street Upland to Milwaukee -22B Project
- Solicitation number
- RFP 25-19137-TF
- Issued by
- Hunt 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 the project and commit to providing a valid insurance certificate with 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 also provide their contact information.
The document outlines key procedural requirements for potential contractors, including the consequences of not meeting the specified time requirements - specifically, the City of Lubbock reserves the right to reject the bid/proposal and award the contract to another contractor. For any questions about the requirements, bidders are instructed to contact the Director of Purchasing & Contract Management at (806) 775-2572. The form provides space for the contractor's original signature, printed name, business name, address, and email, as well as detailed contact information for their insurance agent or broker.
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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 .