6-07 - Insurance Affidavit.pdf
PDF 58 KB Posted
- Attached to
- Demolition for 1302 Erskine
- Solicitation number
- ITB 26-19421-YB
- Issued by
- Hunt County, Texas
About this file
This is an Insurance Affidavit form required by the City of Lubbock, Texas for bidders and offerors responding to the Demolition for 1302 Erskine contract opportunity. The affidavit certifies that the bidder has reviewed all insurance requirements specified in the bid/proposal document in consultation with their insurance agent or broker. Upon notification of contract award by the City, the successful contractor must furnish a valid insurance certificate and all required endorsements within ten (10) business days. The form requires the contractor to provide their business name, address, email, and original signature, along with contact information for their primary and secondary insurance agent or broker, including firm name, contact name, phone number, and email address.
Failure to meet the ten-business-day insurance documentation requirement provides the City of Lubbock the right to reject the bid and award the contract to another contractor. For questions regarding these insurance requirements, bidders should contact the Director of Purchasing & Contract Management for the City of Lubbock 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:
File details come from the government source that posted it. Updated .