7-05 - Insurance Affidavit.pdf
PDF 58 KB Posted
- Solicitation number
- RFQ 25-18963-TF
- Issued by
- Hunt County, Texas
About this file
This document is an Insurance Requirement Affidavit from the City of Lubbock for an unspecified project. The affidavit requires bidders or offerors to certify that they have reviewed the insurance requirements and, if awarded the contract, will provide a valid insurance certificate and endorsements within ten (10) business days of notification. The form is designed for the contractor to confirm their ability to meet the city's insurance standards by having their representative and insurance agent/broker complete and sign the document.
The document provides space for the contractor to enter their business name, address, email, and contact information, as well as details for their insurance agent or broker. A note to contractors indicates that failure to meet the specified time requirements may result in the bid/proposal being rejected, with the contract potentially awarded to another contractor. Contractors with questions are directed to 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 .