ATTACHMENT B NOT OF COMP W INS REQTS.docx
DOCX document 17 KB Posted
- Solicitation number
- 36C25624Q1309
About this file
This document is a Notification of Compliance with Insurance Requirements for a federal contract opportunity with solicitation number 36C25624Q1309. The contractor acknowledges that they will maintain the required insurance types and amounts specified in the contract, including workers' compensation insurance, and that they will provide copies of subcontractor insurance documents upon request. The contract is for preventive maintenance services, repairs, software/hardware upgrades, and equipment installation for Siemens X-Ray units at the Gulf Coast Veterans Health Care System in Biloxi, MS. The contract is issued by the Department of Veterans Affairs, Veterans Health Administration, Veterans Integrated Service Network 16.
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Other files
| File | Type | Posted |
|---|---|---|
| ATTACHMENT A CONTRACTOR CERTIFICATION.docx | DOCX document | |
| 36C25624Q1309.docx | DOCX document |
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ATTACHMENT B – NOTIFICATION OF COMPLIANCE WITH INSURANCE REQUIREMENTS
36C25624Q1309
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 ________________ (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):_____________________________________________
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