Attachment 5 - Insurance Form.pdf
PDF 2 MB Posted
- Attached to
- Repair Dorm B4323 Federal contract opportunity
- Solicitation number
- FA4608-21-R-0004
About this file
This solicitation is for repair work on dormitory building 4323 at Barksdale Air Force Base in Louisiana. The contractor will be responsible for removing and replacing interior finishes in dorm rooms, including wall coverings, flooring, paint, ceilings and doors. The period of performance is 336 calendar days but proposals may specify a different duration. A site visit will be held on November 13, 2020 and interested parties must RSVP by November 5. The work is a woman-owned small business set-aside with an anticipated price range between $5-10 million. The solicitation is issued by the Department of the Air Force Global Strike Command. Funding is not presently available and no award will be made until funds are obligated.
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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
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Address:
Telephone Number:
E-mail Address:
Authorized Signature
Date Typed Name, Rank, Title Authorized Signature
FA4608-20-R-0004
Attachment 5
1101737590C Typewritten Text
1101737590C Typewritten Text
File details come from the government source that posted it. Updated .