8-03 - Insurance Affidavit.pdf
PDF 200 KB Posted
- Attached to
- Landscape & Grounds Maintenance Services for North, South and East Patrol Division Stations.
- Solicitation number
- RFP 26-19638-SR
- 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 RFP 26-19638-SR for Landscape & Grounds Maintenance Services. The affidavit requires the bidder or offeror to certify that they 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, the successful contractor must provide a valid insurance certificate and all required endorsements within ten (10) business days. The form requires the contractor to provide their representative's signature, printed name, business name, address, and email address. Additionally, the contractor must supply complete contact information for their insurance agent or broker, including firm name, contact person, phone number, and email address.
The City of Lubbock reserves the right to reject any bid or proposal if the specified insurance requirements and submission timeline are not met. Bidders with questions regarding insurance requirements should contact the City of Lubbock's Director of Purchasing & Contract Management at (806) 775-2572. This affidavit is a mandatory component of the proposal submission process for the landscaping and grounds maintenance services contract covering the North, South, and East Patrol Division Stations of the Lubbock Police Department.
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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 26-19638-SR
File details come from the government source that posted it. Updated .