ATTACHMENT E NOTIFICATION OF COMPLIANCE WITH INSURANCE REQUIREMENTS.docx
DOCX document 17 KB Posted
- Attached to
- S299--JACC Cable TV and Wi-Fi services
- Solicitation number
- 36C25623Q0945
About this file
This document is a notification of compliance with insurance requirements for federal contract number 36C25623Q0945. The contractor acknowledges that they have read and understood the insurance requirements specified in the contract. They agree to maintain insurance in the amounts and types specified for the duration of the contract and any extensions. The policies will contain an endorsement that any cancellation or material change adversely affecting the government's interests will not be effective for the period prescribed by state law where the contract is being performed, or for 30 days after the insurer or contractor provides written notice to the contracting officer, whichever is longer. The contractor also agrees to maintain state workers' compensation insurance or a letter of reciprocal agreement for the entire performance period of the contract, including any extensions, and to provide copies of subcontractor insurance upon request.
The related federal contract opportunity is solicitation number 36C25623Q0945 to provide cable TV and Wi-Fi services for the Joint Ambulatory Care Center in Pensacola, Florida. The contracting agency is the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 16.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C25623Q0945 0001.docx | DOCX document | |
| ATTACHMENT B LIST OF PAST PERF REF.docx | DOCX document | |
| 36C25623Q0945.docx | DOCX document | |
| ATTACHMENT A Escambia County FL WD 2015-4561 R22 dtd 12-27-2022.pdf | ||
| ATTACHMENT F QASP JACC CABLE TV WIFI.docx | DOCX document | |
| ATTACHMENT C PAST PERFORMANCE QUESTIONNAIRE.doc | DOC document | |
| ATTACHMENT D CONTRACTOR CERTIFICATION.docx | DOCX document |
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Text version
ATTACHMENT E – NOTIFICATION OF COMPLIANCE WITH INSURANCE REQUIREMENTS
36C25623Q0945
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 .