ATTACHMENT D NOTIFICATION OF COMPLIANCE WITH INSURANCE REQUIREMENTS.docx
DOCX document 18 KB Posted
- Attached to
- Medication Dispensing Cabinets service agreement
- Solicitation number
- 36C25626Q1299
About this file
This is a compliance notification template document that contractors must complete and submit to demonstrate adherence to insurance requirements for the Medication Dispensing Cabinets service agreement solicitation. The document serves as an appendix or attachment requirement rather than a substantive specification document, establishing a standardized format for contractors to certify their insurance coverage meets the federal requirements outlined in the primary solicitation documents. Contractors responding to solicitation 36C25626Q1299 issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 16 must complete this notification form as part of their proposal submission to confirm compliance with all mandatory insurance provisions before being considered for award.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C25627P0028_1.pdf | ||
| S06-36C25626Q1299 0001.pdf | ||
| ATTACHMENT F JA_OVER_SAT revised_Redacted.pdf | ||
| 36C25626Q1299_1.pdf | ||
| ATTACHMENT E QASP.docx | DOCX document | |
| ATTACHMENT C CONTRACTOR CERTIFICATION.docx | DOCX document | |
| ATTACHMENT A LIST OF PAST PERFORMANCE REFERENCES.docx | DOCX document | |
| Attachment B Past Performance Questionaire fillable.pdf |
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ATTACHMENT D – NOTIFICATION OF COMPLIANCE WITH INSURANCE REQUIREMENTS
36C25626Q1299
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 .