ATTACHMENT E NOTIFICATION OF COMPLIANCE WITH INSURANCE REQUIREMENTS.docx
DOCX document 17 KB Posted
- Solicitation number
- 36C25623Q1884
About this file
This document is an Attachment E Notification of Compliance with Insurance Requirements form related to solicitation number 36C25623Q1884 for new after hours, as needed courier services for a lab for the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 16. The form acknowledges the contractor has read and understands the insurance requirements specified in the contract. It agrees to maintain insurance in the amounts specified in the contract and any extensions, and to provide notice of any cancellation or change affecting the government's interests. It also agrees to maintain workers' compensation insurance required by the state the contract is performed in. The contractor provides its insurance company contact information and signs to agree this form becomes part of the contract file.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C25623Q1884 0001.docx | DOCX document | |
| 36C25623Q1884.docx | DOCX document | |
| ATTACHMENT B LIST OF PAST PERF REF.docx | DOCX document | |
| ATTACHMENT D CONTRACTOR CERTIFICATION.docx | DOCX document | |
| ATTACHMENT C Past Performance Questionaire fillable.pdf | ||
| ATTACHMENT G BAA Template.doc | DOC document | |
| ATTACHMENT F Quality Assurance Survellance Plan.docx | DOCX document | |
| ATTACHMENT A Hinds County MS WD 2015-5153 R22 dtd 06-30-2023.pdf |
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ATTACHMENT E – NOTIFICATION OF COMPLIANCE WITH INSURANCE REQUIREMENTS
36C25623Q1884
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 .