Attachment 3 - Insurance Compliance.pdf

PDF 2 MB Posted

Attached to
Tree Trimming & Tree Removal Services Federal contract opportunity
Solicitation number
FA483025Q0014
Issued by
Department of the Air Force Air Combat Command

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The associated contract opportunity requires a contractor to provide tree trimming, removal services, stump grinding, debris removal, and brush hogging at Moody Air Force Base and Grassy Pond recreational area. The contractor must supply all necessary labor, equipment, materials, vehicles, aerial platforms and protective equipment. All debris must be transported to an off-base site. The solicitation is being managed by the Department of the Air Force 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

CurrentPage:
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TextField1: FA483025Q0014 - Tree Trimming/Tree Removal Services Attachment 3 - Insurance Compliance
State: GA
CoName:
CoAddress:
CoPolicyNumber:
CoPhoneNumber:
CoEmail:
Remove-Ins-Company:
Add an item:
TextField2:
Date:
Name:
Signature:

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