Attachment 4. Insurance Compliance.pdf
PDF 134 KB Posted
- Attached to
- Aircraft Rescue Firefighting Vehicle Body Repair
- Solicitation number
- FA483025Q0023
About this file
This document is a Notification of Compliance with Contract Insurance Requirements form for a federal contract (RFQ - FA483025Q0023) related to Aircraft Rescue Firefighting Vehicle Body Repair at Moody Air Force Base. The form requires the contractor to acknowledge and comply with specific insurance requirements, including maintaining insurance coverage as specified in FAR 28.307-2, providing notice of policy cancellations, and maintaining Workers' Compensation Insurance throughout the contract performance period.
The form provides blank sections for contractors to fill in details about their insurance companies and contractor information, with spaces for names, addresses, policy numbers, contact information, and authorized signatures. This attachment is part of a solicitation for repairing a 2015 P-23 Oshkosh 3,000-Gallon Aircraft Rescue & Fire Fighting (ARFF) Ultra High Pressure Vehicle that sustained damage, with key procurement details including a site visit on 8 July 2025, question submission deadline of 11 July 2025, and quotation response deadline of 18 July 2025. The solicitation includes a HUBZone small business price evaluation preference and is issued by the Department of the Air Force Air Combat Command.
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Text version
Notification of Compliance with Contract Insurance Requirements
Contract Number: RFQ - FA483025Q0023 Position Title:
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.
Georgia
Insurance Company Information
Name:
Address:
Policy Number:
Telephone Number:
E-mail Address:
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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
Attachment 4.
File details come from the government source that posted it. Updated .