8-03 Insurance Affidavit.pdf

PDF 150 KB Posted

Attached to
North Overton Public Improvement District Landscape Maintenance and Bird Mitigation
Solicitation number
RFP 26-19643-KM
Issued by
Henderson County, Lubbock City, Texas

About this file

This is an Insurance Affidavit document from the City of Lubbock, Texas, related to a landscape maintenance and bird mitigation project for the North Overton Public Improvement District (RFP 26-19643-KM). The affidavit requires bidders and offerors to certify that they have reviewed all insurance requirements specified in the bid/proposal document in consultation with their insurance agent or broker. Bidders must confirm their ability to furnish a valid insurance certificate and endorsements meeting all specified requirements within ten (10) business days after receiving notification of contract award from the City. The form requests contractor representative signature and printed name, business name, address, and email, along with primary and secondary insurance agent/broker contact information including firm name, contact name, phone number, and email address.

The City of Lubbock reserves the right to reject any bid or proposal if the specified time requirement for insurance submission is not met, with the contract potentially being awarded to an alternative contractor. This insurance affidavit is a mandatory compliance document that must be completed and submitted as part of the bidding process. Bidders with questions regarding insurance requirements should contact the City of Lubbock 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:

RFP 26-19643-KM

File details come from the government source that posted it. Updated .