9-05 - Insurance Affidavit.pdf

This is an Insurance Affidavit form required by the City of Lubbock, Texas for bidders and offerors responding to Request for Proposal (RFP) 26-19431-AE related to the West Lubbock Water System Expansion project. The affidavit serves as a certification that bidders have reviewed all insurance requirements specified in the bid/proposal document in consultation with their insurance agent or broker. Bidders must certify their ability to furnish valid insurance certificates and endorsements meeting all stated requirements within ten (10) business days of being notified of contract award by the City. The form requires completion of contractor information including representative name and signature, business name, address, and email, along with primary and secondary insurance agent/broker contact information including firm name, contact person, phone number, and email address.

The affidavit functions as a pre-award insurance compliance document that allows the City of Lubbock to verify contractor capacity to meet insurance obligations before contract execution. Failure to meet the specified insurance requirements within the ten-business-day timeframe provides the City grounds to reject the bid and award the contract to another contractor. Questions regarding insurance requirements should be directed to the City's Director of Purchasing & Contract Management at (806) 775-2572.