7-02 (02) - Insurance Affidavit.pdf
PDF 93 KB Posted
- Solicitation number
- RFP 26-19454-KM
- 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 Bell Farms Public Improvement District (PID) Playa Lake Retaining Wall Construction project. The project involves the removal of an existing retaining wall, construction of a new sidewalk, pedestrian lighting, and landscape improvements within Bell Farms Playa Park, Tract A. Bidders must complete and submit this affidavit certifying that they have reviewed the insurance requirements contained in the bid/proposal documents with their insurance agent or broker. Upon contract award notification from the City, contractors must furnish valid insurance certificates and endorsements meeting all specified requirements within ten (10) business days.
The affidavit requires contractors to provide their business name, address, email address, 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. Questions regarding insurance requirements should be directed to the City of Lubbock's Director of Purchasing & Contract Management at (806) 775-2572. The City reserves the right to reject any bid or proposal if insurance requirements are not met within the specified timeframe and may award the contract to an alternative contractor.
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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 .