5-02 (02) - Insurance Affidavit.pdf

This is an Insurance Affidavit form required by the City of Lubbock, Texas for bidders and offerors on the Water Line to Serve West Texas Veterans Cemetery project. Bidders must complete and submit this affidavit certifying that they have reviewed all insurance requirements outlined in the bid/proposal document with their insurance agent or broker. The affidavit serves as a binding commitment that, upon contract award notification, the contractor will furnish valid insurance certificates and endorsements meeting all specified requirements within ten business days. The form requires the bidder to provide contractor contact information, business name, address, and email, along with primary and secondary insurance agent or broker contact details including firm name, contact person, phone number, and email.

The City of Lubbock reserves the right to reject any bid or proposal if the contractor fails to meet the ten-business-day insurance certificate submission deadline, and the contract may be awarded to another contractor in such cases. Bidders with questions regarding insurance requirements should contact the Director of Purchasing & Contract Management for the City of Lubbock at (806) 775-2572. This affidavit is a mandatory submission component of the bidding process and must be signed by the contractor representative with original signature and printed name.