7-03 Insurance Affidavit.pdf
PDF 193 KB Posted
- Attached to
- Upland Crossing Public Improvement District (PID) Playa Lake Stormwater Drainage Restoration
- Solicitation number
- RFP 26-19456-KM
- Issued by
- Henderson County, Texas
About this file
This is an Insurance Affidavit form required by the City of Lubbock for bidders and offerors responding to contract opportunity RFP 26-19456-KM related to the Upland Crossing Public Improvement District (PID) Playa Lake Stormwater Drainage Restoration project in Lubbock, Texas. The affidavit certifies that the bidder or offeror has reviewed all insurance requirements specified in the bid/proposal documents with their insurance agent or broker. Bidders who are awarded the contract must furnish a valid insurance certificate and endorsements meeting all specified requirements within ten (10) business days of being notified of the award. Questions regarding insurance requirements should be directed to the Director of Purchasing & Contract Management for the City of Lubbock at (806) 775-2572.
The form requires the contractor representative to provide their original signature and printed name, along with the contractor's business name, address, and email address. The affidavit also requires contact information for the insurance agent or broker(s), including firm name, contact name, phone number, and email address. The City reserves the right to reject any bid/proposal if the contractor fails to meet the specified insurance requirement timeline. This affidavit is a mandatory submission component for all bidders participating in this procurement process.
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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 26-19456-KM
File details come from the government source that posted it. Updated .