6-05 - Insurance Affidavit.pdf
PDF 134 KB Posted
- Attached to
- Terminal Storage Reservoir Valve Replacement
- Solicitation number
- RFP 25-19440-AE
- Issued by
- Hunt County, Texas
About this file
This is an Insurance Affidavit form for the City of Lubbock, Texas, related to RFP 26-19440-AE for the Terminal Storage Reservoir Valve Replacement project. The affidavit must be completed and signed by bidders or offerors as part of their proposal submission. Bidders are required to certify that they have reviewed all insurance requirements contained in the bid/proposal document with their insurance agent or broker. If awarded the contract, contractors must provide a valid insurance certificate and endorsements meeting all specified requirements within ten (10) business days of receiving notification of award from the City. The form requires the contractor representative's original signature and printed name, along with the contractor's business name, address, and email address. Contact information for both the primary and secondary insurance agent or broker must also be provided on the affidavit.
The City of Lubbock reserves the right to reject any bid or proposal if the contractor fails to meet the stated time requirement for submitting insurance documentation. Contractors with questions regarding the insurance requirements should contact the Director of Purchasing & Contract Management for the City of Lubbock at (806) 775-2572. This affidavit serves as the bidder's certification of compliance with the City's insurance requirements and their ability to meet the specified deadlines for providing proof of insurance coverage upon contract award.
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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
RFP 26-19440-AE
File details come from the government source that posted it. Updated .