ATTACHMENT H NOTIFICATION OF COMPLIANCE WITH INSURANCE REQUIREMENTS.docx
DOCX document 18 KB Posted
- Attached to
- Home Sleep Apnea Testing Service
- Solicitation number
- 36C25626Q0736-1
About this file
This is a notification and acknowledgment form for contractor compliance with insurance requirements for a federal contract. The document serves as a binding agreement wherein the contractor confirms understanding of and commitment to maintaining all insurance coverage specified in solicitation 36C25626Q0736 for Home Sleep Apnea Testing services with the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 16. The contractor must maintain insurance in the types and amounts designated throughout the contract period, including any modifications or time extensions.
The form requires the contractor to ensure that insurance policies contain endorsements protecting the Government's interest in the event of cancellation or material adverse changes, with notice requirements complying with state law or providing 30 days' written notice to the Contracting Officer, whichever is longer. The contractor must also maintain state-mandated Workmen's Compensation Insurance or provide a letter of reciprocal agreement with another state for the entire performance period. Additionally, the contractor is responsible for obtaining and maintaining copies of all subcontractors' proof of insurance and making such documentation available to the Contracting Officer upon request. The form includes designated spaces for the contractor to identify insurance company names and telephone numbers, provide contractor identification information, and authorize the agreement through signature and date.
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ATTACHMENT H – NOTIFICATION OF COMPLIANCE WITH INSURANCE REQUIREMENTS
36C25626Q0736
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 .