7-03 Insurance Affidavit.pdf
PDF 152 KB Posted
- Attached to
- Automated Teller Machine Services
- Solicitation number
- RFP 26-19502-KM
- Issued by
- Hunt County, Texas
About this file
This is an Insurance Affidavit form for the City of Lubbock, Texas, related to RFP 26-19502-KM for Automated Teller Machine Services. The affidavit must be completed by bidders or offerors as part of their proposal submission. Bidders are required to certify that they have reviewed the insurance requirements specified in the bid/proposal document with their insurance agent or broker. Upon contract award notification from the City, successful contractors must provide valid insurance certificates and endorsements meeting all specified requirements within ten (10) business days. Failure to meet this time requirement provides the City with the right to reject the bid/proposal and award the contract to another contractor.
The form requires bidders to provide contractor representative information (signature and printed name), business name, address, and email address. Additionally, bidders must supply contact information for their primary and secondary insurance agents or brokers, including firm names, contact names, phone numbers, and email addresses. 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 26-19502-KM
File details come from the government source that posted it. Updated .