6-03 - Insurance Affidavit.pdf
PDF 289 KB Posted
- Attached to
- Stormwater Storage Mowing & Litter Control
- Solicitation number
- ITB 25-18966-AE
- Issued by
- Harris County, Texas
About this file
This document is an Insurance Requirement Affidavit from the City of Lubbock for Project Number 25-18966-AE. The affidavit requires the bidder or offeror to certify that they have reviewed the insurance requirements and, if awarded the contract, will provide a valid insurance certificate and endorsements within ten (10) business days of notification. The document outlines the contractor's commitment to meet the city's insurance standards and provides spaces for the contractor's representative, business information, and insurance agent/broker contact details.
The form serves as a formal commitment by the potential contractor to comply with the City of Lubbock's insurance requirements. It includes a note that failure to meet the specified time requirements may result in the city rejecting the bid/proposal and awarding the contract to another contractor. The document provides contact information for the Director of Purchasing & Contract Management at (806) 775-2572 for any questions regarding the requirements.
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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:
184487 Typewritten Text
25-18966-AE
File details come from the government source that posted it. Updated .