Atch 6 - Insurance Compliance.pdf
PDF 2 MB Posted
- Attached to
- WACoE Support Services at Moody AFB
- Solicitation number
- FA483021QS017
About this file
This document contains an insurance compliance notification form for a federal contract. The form acknowledges the contractor has read and understands the insurance requirements specified in the contract. It provides notification that the required insurance policies will be maintained at the amounts stated in FAR 28.307-2 for the duration of the contract, including any extensions. The policies will contain an endorsement that any cancellation or material changes will not take effect for the period prescribed by state law or 30 days after notice is given to the Contracting Officer, whichever is longer. It also confirms workers' compensation insurance or a reciprocal agreement will be maintained for the life of the contract. The contractor agrees to provide copies of subcontractor insurance proofs upon request.
The related federal contract opportunity is a solicitation to provide personal Exercise Physiologist and Certified Athletic Trainer Services and non-personal Administrative Assistant Services for the 93d Air Ground Operations Wing at Moody Air Force Base in Georgia. The requirement is referred to collectively as Warrior Athlete Center of Excellence Support Services. The contracting agency is the Department of the Air Force under the Air Combat Command.
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Notification of Compliance with Contract Insurance Requirements Page of 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 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 Information Name:
Address:
Policy Number:
Telephone Number:
E-mail Address:
Contractor Information Name:
Address:
Telephone Number:
E-mail Address:
Authorized Signature 9.0.0.2.20120627.2.874785
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