ATTACHMENT D NOTIFICATION OF COMPLIANCE WITH INSURANCE REQUIREMENTS.docx
DOCX document 18 KB Posted
- Attached to
- Q301--Genetic Testing Services for P&LMS, LR, AR Federal contract opportunity
- Solicitation number
- 36C25626Q0837
About this file
This is a template form for contractor notification of compliance with insurance requirements for federal contract 36C25626Q0837. The document serves as an acknowledgment that the contractor has reviewed and agrees to maintain all insurance coverage specified in the contract at the required amounts and types throughout the contract period and any modifications or extensions. The contractor certifies that insurance policies will include endorsements notifying the Contracting Officer of any cancellations or material changes adversely affecting the Government's interest, with notice requirements governed by state law or within 30 days of insurer or contractor notification to the Contracting Officer, whichever is longer. The contractor also confirms that state Workers' Compensation Insurance or a reciprocal agreement with another state will be maintained for the entire performance period.
The form includes blank fields for the contractor to insert the name(s) and telephone number(s) of the insurance company(ies), contractor name and address, authorized signature, date, and typed name and title. Additionally, the contractor agrees to maintain copies of all subcontractors' proof of insurance and make these documents available to the Contracting Officer upon request. This notification becomes part of the contract file for solicitation 36C25626Q0837, which is for genetic testing services for the Central Arkansas Veterans Healthcare System's Pathology & Laboratory Medicine Service with a performance period from August 1, 2026 through July 31, 2027, plus four optional one-year renewal periods.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 36C25626Q0837 0001.pdf | ||
| ATTACHMENT E Quality Assurance Surveillance Plan.docx | DOCX document | |
| ATTACHMENT C CONTRACTOR CERTIFICATION.docx | DOCX document | |
| 36C25626Q0837_1.docx | DOCX document | |
| Attachment B Past Performance Questionaire fillable.pdf | ||
| ATTACHMENT A LIST OF PAST PERF REF.docx | DOCX document | |
| 36C25626Q0837.pdf |
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Text version
ATTACHMENT D – NOTIFICATION OF COMPLIANCE WITH INSURANCE REQUIREMENTS
36C25626Q0837
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):________________________________________________________
File details come from the government source that posted it. Updated .