Atch -3-Contractor Insurance-FA460826B0001.pdf
PDF 193 KB Posted
- Attached to
- Barksdale AFB Timber Sale
- Solicitation number
- FA460826B0001
About this file
This is a Notification of Compliance with Contract Insurance Requirements form for federal contract FA460826B0001. The document is a template that contractors complete to acknowledge their understanding of and compliance with contract insurance obligations. Contractors must certify that they will maintain insurance in the amounts and types specified in FAR 28.307-2 throughout the contract performance period and any modifications or extensions. The required insurance policies must include an endorsement stipulating that cancellations or material changes adversely affecting the Government's interest cannot take effect until the later of: (1) the period prescribed by state law in the contract performance location, or (2) thirty calendar days after written notice to the Contracting Officer from the insurer or contractor. Contractors are also required to maintain state Workers' Compensation Insurance or a reciprocal agreement letter for the entire performance period and any contract modifications or extensions. Additionally, contractors must maintain and provide copies of all subcontractors' proofs of required insurance to the Contracting Officer upon request.
The form requires completion of three main sections: Insurance Company information (name, address, policy number, telephone, and fax), Contractor information (company name and address), and authorization signature and date fields. The document serves as a legally binding and enforceable agreement that becomes part of the subject contract.
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Text version
FA460826B0001
Attachment 3
Notification of Compliance with Contract Insurance Requirements
The undersigned Contractor hereby acknowledges that he/she has read and understands the insurance requirements specified in this contract and hereby provides notification (1) that such insurance shall be maintained in at least the amounts and types as stated in FAR 28.307-2 and during any modifications and/or time extensions granted thereto; (2) that the required insurance policies shall contain an endorsement to the effect that any cancellation of material changes adversely affecting the Government's interest shall not be effective for such period as the laws of the State in which this contract is to be performed prescribe, or until thirty (30) calendar days after the insurer or contractor gives written notice to the Contracting Officer, whichever period is longer; (3) that _____________ (state) Workers' Compensation Insurance, or letter of reciprocal agreement with another state, shall be maintained on this contract for and during the entire performance period and for any modifications and/or time extensions granted thereto; and (4) that a copy of all subcontractors' proofs of required insurance shall be maintained and shall be made available to the Contracting Officer upon request. This agreement shall be a part of subject contract and shall be legally binding and enforceable at law.
INSURANCE COMPANY(S):
Name:
Address:
Policy #:
Telephone #:
Fax #: _____________________________________________________________
CONTRACTOR:
Company Name:
Address:
(Typed Name and Title) (Date)
(Authorized Signature)
File details come from the government source that posted it. Updated .