8-03 Insurance Affidavit.pdf
PDF 150 KB Posted
- Solicitation number
- RFP 26-19659-KM
- 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 26-19659-KM regarding 457(b) Deferred Compensation Plan recordkeeping and administration services. 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. Bidders must complete the affidavit by providing their business name, address, email contact information, and contractor representative signature. Additionally, bidders must provide their insurance agent or broker's firm name, contact person, phone number, and email address.
Upon contract award by the City of Lubbock, the successful contractor must furnish a valid insurance certificate and all required endorsements within ten (10) business days of notification. The City reserves the right to reject any bid or proposal if this time requirement is not satisfied, and may award the contract to another contractor. 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 26-19659-KM
File details come from the government source that posted it. Updated .