Attachment 3 - Insurance Form.pdf
PDF 3 MB Posted
- Attached to
- MACC Barksdale AFB (Solicitation) Federal contract opportunity
- Solicitation number
- FA4608-22-R-0001
About this file
This document contains an insurance notification form for a federal contract. The form notifies the contracting officer that the contractor will maintain insurance in the amounts specified by FAR 28.307-2, including workers' compensation, for the entire performance period of the contract and any extensions. The insurance policies will contain an endorsement to notify the contracting officer of any cancellation or material changes at least 30 days in advance or the time required by state law, whichever is longer. The contractor must provide proof of insurance for any subcontractors upon request from the contracting officer. The authorized contractor representative must sign and date the form to acknowledge these requirements.
The related federal opportunity is a solicitation for the Multiple Award Construction Contract at Barksdale Air Force Base. The IDIQ contract will be used to satisfy a variety of construction and design-build projects at the base. This is an 8(a) and socio-economic small business set-aside solicitation issued by the Department of the Air Force Global Strike Command.
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Text version
Notification of Compliance with Contract Insurance Requirements
Contract Number:
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:
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Contractor Information
Name:
Address:
Telephone Number:
E-mail Address:
Authorized Signature
Date Typed Name, Rank, Title Authorized Signature
FA460822R0001
Attachment 3
1101737590C Typewritten Text
1101737590C Typewritten Text
File details come from the government source that posted it. Updated .