Attachment 4 - Insurance Cert.pdf

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Attached to
Copper Plant Upgrade Federal contract opportunity
Solicitation number
FA667020B0001
Issued by
Department of the Air Force Reserve Command

About this file

This solicitation notice is for a firm fixed price construction contract to upgrade the copper cable plant at Niagara Falls Air Reserve Station to a fiber optic cable system. The project includes directional boring, fiber pulling, splicing and testing, as well as open-pit trenching to install conduit for the new fiber optic cable. The contractor will furnish all labor, materials, equipment, transportation and supervision to complete the upgrade. The estimated value is between $500,000 and $1,000,000. The solicitation is set aside 100% for woman-owned small businesses. The period of performance is 180 days from notice to proceed. Liquidated damages and payment and performance bonds are required. The solicitation will be available on SAM and the pre-bid site visit has been scheduled. Questions must be submitted in writing to the contracting office.

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Text version

ACKNOWLEDGEMENT, AGREEMENT AND CERTIFICATION OF COMPLIANCE

WITH CONTRACT INSURANCE REQUIREMENTS

CONTRACT NUMBER FA667020B0001

The undersigned Contractor hereby acknowledges that he/she has read and understands the insurance requirements specified in this contract, and hereby certifies; 1) that such insurance has been obtained and agrees that said insurance will be maintained in at least the amount and types specified in this contract and during any modifications and/or time extensions granted thereto; 2) that these required insurance policies will each contain an endorsement to the effect that cancellation of any material change to the insurance policies adversely affecting the interest of the government shall not be effective for such period as may be prescribed by the laws of the State in which this contract is to be performed and in no event less than thirty (30) days after written notice thereof has been given to the Contracting Officer; 3) that New York State Workmen's 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 and during any modifications and/or time extensions granted thereto; 4) where shall ensure that each subcontractor possesses current certification of insurance satisfying the contract requirements; and

5) that this agreement shall become a part of the above referenced contract and shall be legally binding and enforceable by Law.

(CONTRACTOR) (INSURANCE COMPANY NAME)

(STREET ADDRESS) (STREET ADDRESS)

(CITY, STATE, ZIP) (CITY, STATE, ZIP)

(AUTHORIZED SIGNATURE, DATE) (AGENT, TELEPHONE NUMBER)

(TYPED NAME AND TITLE) (POLICY NUMBER)

ACCEPTANCE

The undersigned Contracting Officer, on behalf of the United Sates of America, hereby accepts the above Agreement and Certification and hereby incorporates the above Agreement into the above referenced contract in full text in compliance with FAR 52.228-5 or 52.228-8, as applicable.

UNITED STATES OF AMERICA

DATE:_____________________

_ MSG PK

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