7-08 - Insurance Affidavit.pdf
PDF 58 KB Posted
- Attached to
- Cemetery - Irrigation Pump Station
- Solicitation number
- ITB 26-19316-TF
- Issued by
- Hunt County, Texas
About this file
This is an Insurance Affidavit form required by the City of Lubbock, Texas for bidders and offerors on the Cemetery - Irrigation Pump Station project. The affidavit certifies that the bidder has reviewed all insurance requirements specified in the bid/proposal document in consultation with their insurance agent or broker. Upon notification of contract award by the City, the successful contractor must furnish valid insurance certificates and endorsements meeting all specified requirements within ten business days. The City of Lubbock reserves the right to reject any bid/proposal if the contractor fails to meet this time requirement. Bidders must provide contractor representative information, business details, and contact information for their insurance agent or broker on the form.
The affidavit does not specify particular insurance coverage amounts, types, or pricing terms within this document. Bidders or offerors are directed to review the complete bid/proposal package for detailed insurance requirements and should contact the Director of Purchasing & Contract Management at (806) 775-2572 with any questions regarding these requirements. The form serves as a pre-award compliance certification ensuring that selected contractors can promptly provide necessary insurance documentation.
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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 .