ATTACHMENT 4 NOTIFICATION OF COMPLIANCE WITH INSURANCE REQUIREMENTS.docx
DOCX document 17 KB Posted
- Attached to
- INSTRUMENT TRANSPORT CONTRACT
- Solicitation number
- 36C25624Q0528
About this file
This document is an attachment to a federal contract notifying compliance with insurance requirements. The attachment requires the contractor to acknowledge and agree that the specified insurance in the contract will be maintained at or above the stated amounts and types. The contractor must also agree that any policy cancellations or material changes adversely affecting the government's interests will not be effective for the period prescribed by the state law where the contract is performed, or for 30 days after written notice is provided to the contracting officer, whichever is longer. The contractor must also maintain the specified state workers' compensation insurance or a letter of reciprocal agreement for the entire performance period of the contract, including any modifications or time extensions. The contractor must make copies of all subcontractors' proof of insurance available to the contracting officer upon request.
The related federal contract opportunity is a solicitation for daily transport courier services for the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 16. The solicitation number is 36C25624Q0528 and is for the transportation of instruments under contract line item number R602-520-24-2-205-0027.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C25624Q0528 0001.docx | DOCX document | |
| ATTACHMENT 2 LIST OF PAST PERFORMANCE REFERENCES.docx | DOCX document | |
| ATTACHMENT 3 PAST PERFORMACE QUESTIONAIRE.docx | DOCX document | |
| QASP - Instrument Transportation Courier Contract 2024.docx | DOCX document | |
| Harrison Co Wage Determination 2015-5147.pdf | ||
| 36C25624Q0528_1.docx | DOCX document | |
| ATTACHMENT 1 CONTRACTOR CERTIFICATION.docx | DOCX document |
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Text version
ATTACHMENT 4 – NOTIFICATION OF COMPLIANCE WITH INSURANCE REQUIREMENTS
36C256-22-Q-0932
NOTIFICATION OF COMPLIANCE WITH INSURANCE REQUIREMENTS
The undersigned Contractor hereby acknowledges that he or 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 _MS_______________ (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 time extensions granted thereto; and (4) that a copy of all subcontractors’ proof of 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.
INSURANCE COMPANY(S): ____________________________________
(NAME[S]) (TELEPHONE NUMBER[S]): ______________________________________________
CONTRACTOR: ____________________________________________
(NAME): __________________________________________________
(ADDRESS): _______________________________________________
(AUTHORIZED SIGNATURE) (DATE): _______________________________________________
(TYPED NAME AND TITLE):________________________________________________________
File details come from the government source that posted it. Updated .