7-05 - Insurance Affidavit.pdf
PDF 146 KB Posted
- Attached to
- Bailey County Transmission Line Upgrade
- Solicitation number
- RFP 25-19178-AE
- Issued by
- Hunt County, Texas
About this file
This document is an Insurance Requirement Affidavit for the City of Lubbock, specifically for Project Number RFP 25-19178-AE. The affidavit requires the bidder/offeror to confirm that they have reviewed the insurance requirements and will be able to provide a valid insurance certificate and endorsements within ten (10) business days of being awarded the contract. The document provides space for the contractor to enter their business name, address, and contact information, as well as details for their insurance agent or broker.
The form emphasizes that if the time requirements are not met, the City of Lubbock reserves the right to reject the bid/proposal and award the contract to another contractor. For any questions, bidders are instructed to contact the Director of Purchasing & Contract Management at (806) 775-2572. The document serves as a formal commitment by the potential contractor to comply with the city's insurance requirements for the specified project.
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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:
184487 Typewritten Text
RFP 25-19178-AE
File details come from the government source that posted it. Updated .