Attachment 8 - Insurance Compliance.pdf
PDF 2 MB Posted
- Solicitation number
- FA483023Q0107
About this file
This document is an insurance compliance notification form for a federal contractor. The form requires the contractor to acknowledge understanding of the insurance requirements specified in the relevant contract. It must maintain at least the amounts and types of insurance stated in FAR 28.307-2 for the duration of the contract and any extensions. Required policies must contain an endorsement noting that any cancellation or material changes will not take effect for the period prescribed by the state's laws where the contract is being performed, or 30 calendar days after the insurer or contractor provides written notice to the contracting officer, whichever is longer. The contractor must also maintain workers' compensation insurance or a letter of reciprocal agreement for the entire performance period and any extensions. Upon request, the contractor must provide the contracting officer copies of insurance proofs from all subcontractors. The authorized contractor representative must sign and date the form, and provide the requested company information.
The related federal contract opportunity is a solicitation from the Department of the Air Force Air Combat Command to provide studio photographer services for the Moody Air Force Base Public Affairs office.
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Notification of Compliance with Contract Insurance Requirements Page of 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:
Contractor Information Name:
Address:
Telephone Number:
E-mail Address:
Authorized Signature 9.0.0.2.20120627.2.874785
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File details come from the government source that posted it. Updated .