8-03 - Insurance Affidavit.pdf
PDF 284 KB Posted
- Attached to
- Refuse Truck Hydraulic Cylinder Repair
- Solicitation number
- ITB 25-19009-AE
- Issued by
- Hunt County, Texas
About this file
This document is an Insurance Requirement Affidavit from the City of Lubbock for Project Number 25-19009-AE. The affidavit requires the bidder or offeror 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 document includes space for the contractor's representative to sign and provide business contact information, as well as details for their insurance agent or broker.
The affidavit serves as a formal commitment by the potential contractor to meet the City of Lubbock's insurance requirements for the specified project. It includes a note that if the time requirements are not met, the City reserves the right to reject the bid/proposal and award the contract to another contractor. Contractors with questions are instructed to contact the Director of Purchasing & Contract Management 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:
184487 Typewritten Text
25-19009-AE
File details come from the government source that posted it. Updated .