6-03 Insurance Affidavit.pdf
PDF 85 KB Posted
- Attached to
- Airport Terminal Advertising Concessions
- Solicitation number
- RFP 26-19432-KM
- Issued by
- Hunt County, Texas
About this file
This is an Insurance Affidavit form used by the City of Lubbock, Texas for the Airport Terminal Advertising Concessions solicitation (RFP 26-19432-KM). The affidavit requires bidders and offerors to certify that they have reviewed all insurance requirements contained in the bid/proposal document in consultation with their insurance agent or broker. Bidders must confirm their ability to furnish a valid insurance certificate and endorsements meeting all specified requirements within ten business days of being notified of contract award by the City. The form requests contractor information including business name, address, email, and contact details for the primary and secondary insurance agents or brokers.
The document serves as a compliance mechanism to ensure contractor insurance readiness prior to contract execution. Bidders must complete the affidavit by providing an original signature from the contractor representative along with printed name and company information. Any bidder failing to meet the specified insurance timeline requirements may have their bid rejected by the City, which retains the right to award the contract to another contractor. Questions regarding insurance requirements should be directed to the City of Lubbock's Director of Purchasing & Contract Management at (806) 775-2572.
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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:
RFP 26-19432-KM
File details come from the government source that posted it. Updated .