Attachment 3 Contractor Insurance.pdf
PDF 212 KB Posted
- Attached to
- Barksdale AFB Timber Sale
- Solicitation number
- FA460825QS051
About this file
This document is a Notification of Compliance with Contract Insurance Requirements form for contract FA4608-25-B-0001, Attachment 3. The form requires the contractor to acknowledge and confirm compliance with specific insurance requirements, including maintaining insurance coverage in amounts specified by FAR 28.307-2, providing policy endorsements that protect the government's interests, maintaining state Workers' Compensation Insurance, and keeping copies of subcontractors' insurance proofs available for review. The form provides blank spaces for the contractor to fill in details about their insurance company and contact information, and includes spaces for the contractor's company name, address, authorized signature, and date of completion.
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Text version
FA4608-25-B-0001
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 .