5-RFP 3903 INSURANCE AFFIDAVIT.pdf
PDF 142 KB Posted
- Attached to
- Ammonia Chemical Feed Skid
- Solicitation number
- RFP # 3903
- Issued by
- Riverside County, California
About this file
This is an Insurance Affidavit form for RFP #3903 related to a California state and local contract opportunity for the purchase of a liquid ammonium sulfate and 12.5% sodium hypochlorite chemical dosing skid system. The affidavit requires proposers to certify that they have reviewed and agree to furnish all insurance policies with designated limits, full endorsements, and waiver of subrogation as specified in the Insurance Requirements (Rev. 05/2021) for the full contract term. Successful proposers must submit copies of insurance certificates, endorsements, and waiver of subrogation documentation within fourteen calendar days of the District's notification of award recommendation. The form includes a submittal checklist and allows proposers to note any exceptions, additions, deletions, or modifications to the stated insurance requirements on a separate Additions, Deletions and/or Exceptions Form.
Failure to maintain the required insurance coverage is grounds for contract termination. The District will issue an agreement in its standard form to the successful firm(s). Proposers who do not accept the insurance terms and conditions as stated in the Insurance Requirements (Rev. 05/2021) must detail all exceptions and modifications on the designated form and submit this documentation as part of the proposal package.
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INSURANCE AFFIDAVIT
RFP #3903
I, (Proposer/Company) have reviewed the Insurance Requirements (Rev. 05/2021) in its entirety and agree to furnish all insurance policies with designated limits, along with full endorsements, and waiver of subrogation, as stated in this Request for Proposal for the full term of the agreement.
I hereby agree to provide copies of insurance certificates, endorsements, and waiver of subrogation within fourteen (14) calendar days of the District’s notification of recommendation of award.
I understand and confirm that our firm is able to provide and maintain the coverage as specified.
Failure to maintain said coverage shall be sufficient cause for contract termination and shall result in termination of the awarded contract.
I understand that by signing this document, I (Proposer/Company) agree to all terms and conditions as stated in the Insurance Requirements (Rev. 05/2021).
☐ Check here if you DO NOT accept terms and conditions as stated in the Insurance Requirements (05/2021). Detail all Exceptions in, Additions, Deletions and/or Exceptions Form.
Authorized Representative’s Signature Name Authorized Representative’s Printed Name
Company Name Date
Mailing Address Telephone
City, State, Zip Code Email
| RFP #3903 PRICE FORM |
| LIST OF SUBCONTRACTORS |
| ADDITIONS, DELETIONS AND/OR EXCEPTIONS |
| District will issue an Agreement in its standard form to the successful firm(s) for the services contemplated herein; a copy of which is attached hereto and incorporated herein. Any deletion, exception, or modification taken to District contract terms... |
| ☐ Check here if you DO NOT accept terms and conditions as stated in the Insurance Requirements (05/2021). Detail all Exceptions in, Additions, Deletions and/or Exceptions Form. |
| (This document is to be submitted with the proposal package) (rev. 10/08/18) |
SUBMITTAL CHECK-OFF LIST
| Requirements Rev 052021 in its entirety and agree to furnish all insurance policies with: |
| Check here if you DO NOT accept terms and conditions as stated in the Insurance: Off |
| Company Name: |
| Mailing Address: |
| City State Zip Code: |
| Authorized Representatives Printed Name: |
| Date_6: |
| Telephone: |
| Email: |
File details come from the government source that posted it. Updated .