9-05 - Insurance Affidavit.pdf

This is an Insurance Affidavit form required by the City of Lubbock, Texas for bidders and offerors participating in competitive sealed bid processes. The form is specifically associated with Invitation to Bid (ITB) 26-19283-AE for the 2026 Concrete Replacement project, which involves the replacement of concrete for various street maintenance projects throughout the city. Bidders must complete and submit the affidavit as part of their bid package, certifying that they have reviewed the insurance requirements in the bid/proposal document with their insurance agent or broker. The affidavit requires the contractor representative's original signature, printed name, business name, address, and email address, along with contact information for up to two insurance agents or brokers.

The critical requirement stated in the affidavit is that contractors must furnish valid insurance certificates and endorsements meeting all specified requirements within ten (10) business days after receiving notification of contract award from the City. Failure to meet this deadline gives the City the right to reject the bid and 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. The affidavit serves as a pre-award certification mechanism to ensure contractor compliance with the city's insurance coverage mandates before contract execution.