9-05 - Insurance Affidavit.pdf
PDF 152 KB Posted
- Attached to
- Phase 7 Waterline Change Out
- Solicitation number
- RFP 26-19424-AE
- Issued by
- Henderson County, Lubbock City, Texas
About this file
This is an Insurance Affidavit form required by the City of Lubbock, Texas, for bidders and offerors responding to RFP 26-19424-AE, which concerns Phase 7 Waterline Change Out involving the replacement of a 2" waterline. The affidavit must be completed and signed by the bidder or offeror, certifying that insurance requirements specified in the bid/proposal document have been reviewed in consultation with the bidder's insurance agent or broker. If awarded the contract, the successful contractor must furnish a valid insurance certificate with all required endorsements within ten (10) business days after notification of award by the City.
The affidavit form requires the contractor to provide standard identification information including business name, address, and email, as well as contact information for the insurance agent or broker facilitating the coverage. Bidders failing to meet the ten-day insurance submission requirement are subject to bid rejection, and the City reserves the right to award the contract to another contractor. Questions regarding insurance requirements should be directed to the City of Lubbock's 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:
184487 Typewritten Text
RFP 26-19424-AE
File details come from the government source that posted it. Updated .