7-05 - Insurance Affidavit.pdf

PDF 58 KB Posted

Attached to
On-Call Consulting Services at Lubbock Preston Smith International Airport
Solicitation number
RFQ 26-19404-TF
Issued by
Henderson 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 On-Call Consulting Services contract opportunity at Lubbock Preston Smith International Airport. The affidavit certifies that bidders have reviewed all insurance requirements specified in the bid/proposal document in consultation with their insurance agent or broker. Upon contract award notification by the City, bidders commit to furnishing valid insurance certificates and endorsements meeting all specified requirements within ten (10) business days. The form requires completion of contractor information including business name, address, email, contractor representative signature, and contact details for primary and secondary insurance agents or brokers. The City of Lubbock reserves the right to reject any bid/proposal if insurance requirements and timelines are not satisfied.

Bidders requiring clarification on insurance requirements should contact the Director of Purchasing & Contract Management for the City of Lubbock at (806) 775-2572. This affidavit is a mandatory submission component of the bid/proposal package and must be signed by the contractor representative before submission. No specific scope of work fees, hourly rates, or fixed proposal costs should be included in the initial statements of qualifications submittal for this on-call consulting services opportunity.

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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 .