Attachment 4 - Insurance Certificate.docx

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Attached to
Security System Upgrades
Solicitation number
W911S825BA016
Issued by

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This document is a Certificate of Compliance with Insurance Requirements for Solicitation No. W911S8-24-R-0003, related to a security system upgrades project at Joint Base Lewis-McChord. The certificate requires the contractor to maintain specified insurance types and amounts, provide notice of policy changes, and ensure Washington State Workers' Compensation Insurance is maintained throughout the contract performance period.

The associated federal contract opportunity involves a firm-fixed price construction contract for security system upgrades, set aside specifically for HUBZone businesses. The project is valued between $250,000 and $500,000, falls under NAICS code 236220, and requires procurement of ICIDS-V equipment components from authorized resellers. The performance period is 120 calendar days after the Notice to Proceed, and the solicitation is issued by the Department of the Army Materiel Command Mission and Installation Contracting Command at Joint Base Lewis-McChord, Washington.

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Other files

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Attachment 2 - Statement of Work.pdf PDF
Attachment 3 - General Decision WA20250111_07182025.pdf PDF
Attachment 6 - DD Form 2772 Contract Discrepancy Report.pdf PDF
Attachment 9 - ENG FORM 4288-R Submittal Register.xlsx XLSX spreadsheet
IFB W911S825BA016_081825.pdf PDF
Attachment 1 - Floor Plan.pdf PDF
Attachment 5 - AF FORM 3065 Contract Progress Report.pdf PDF
Attachment 7 - ENG Form 4025-R Shop Drawings.pdf PDF
Attachment 8 - Daily Inspection Report.pdf PDF
Attachment 11 - HJB Form 225_Instructions.pdf PDF
Attachment 12 - Certified Payroll Instructions.pdf PDF
Attachment 13 - Contractor Vendor Pass Request (Up to 90 Days).pdf PDF
Attachment 14 - Contractor AIE Long Term Badge Application.docx DOCX document
Attachment 10 - HJB FORM 225.pdf PDF
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CERTIFICATE OF COMPLIANCE WITH INSURANCE REQUIREMENTS

SOLICITATION NO. W911S8-24-R-0003

The undersigned Contractor hereby acknowledges that he/she has read and understands the insurance requirements specified in this contract and hereby agrees (1) that such insurance will be maintained in, at least, the amounts and types specified in this contract and during any modifications and/or time extensions granted thereto; (2) that the policies evidencing required insurance shall contain an endorsement to the effect that any cancellation or any material change 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 30 days after the insurer or contractor gives written notice to the Contracting Officer, whichever period is longer; (3) that Washington (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 any modifications and/or time extensions granted thereto; and (4) that a copy of all subcontractors’ proof of required insurance shall be maintained and shall be made available to the Contracting Officer upon request. This agreement shall become a part of the above referenced contract file and is in effect for the entire period of performance specified in the contract.

INSURANCE COMPANY (IES):

______________________________________________________________
(Name(s))(Telephone No.)

CONTRACTOR:

(Name)

(Address) (Authorized Contractor Representative Signature) (Date)

(Typed/Printed Name and Title)

File details come from the government source that posted it. Updated .