Attachment K Broker Information.docx
DOCX document 13 KB Posted
- Attached to
- Business Automobile Insurance
- Solicitation number
- ITB-13707
- Issued by
- Polk County, Florida
About this file
This document is an Attachment K Broker Information form designed to collect critical contact and administrative details for a broker participating in a state or local contract opportunity. The form requires comprehensive information including the broker's name, Federal Employer Identification Number (FEIN), primary work locations, and detailed contact information for the individuals responsible for administering the insurance policy and answering questions about the bid.
The form is structured to capture essential administrative contact details, with specific sections requesting the name, title, street address, email, phone numbers, fax number, and emergency contact information for two key personnel: the person responsible for administering the insurance policy and the individual responsible for answering bid-related questions. While the document does not provide specific details about the contract's scope, value, or terms, it serves as a critical administrative template for broker identification and communication purposes in a procurement process.
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| Attachment G PUR 7801 Vendor Certification Form.docx | DOCX document | |
| Attachment D ATCs.pdf | ||
| Attachment L Expiring Policy.pdf | ||
| Attachment B Mandatory Responsive Requirements.docx | DOCX document | |
| Attachment I PUR 1355.docx | DOCX document | |
| Attachment J Certification Drug Free.docx | DOCX document | |
| Business Auto Q&A Addendum No. 1.pdf | ||
| Attachment M Historical Loss Experience.pdf | ||
| Attachment N Auto Usage.pdf | ||
| _ITB Business Automobile Insurance.pdf | ||
| Attachment C Revised Price Sheet .xlsx | XLSX spreadsheet | |
| Attachment H Draft Contract.pdf | ||
| Attachment E ESTC 9.12.2024.pdf | ||
| Attachment A Scope of Work.pdf | ||
| Attachment F PUR 1000 General Contract Conditions.pdf | ||
| Attachment C Price Sheet.xlsx | XLSX spreadsheet |
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Text version
Attachment K Broker Information
Broker Name:
FEIN:
Primary Location(s) where the work will be performed:
Street Address: City: State:
Please identify the person who is to be responsible for administering the Insurance Policy on your behalf if award is made.
Name:
Title:
Street Address:
E-mail Address:
Phone Number(s):
Fax Number:
Emergency Number:
If the person responsible for answering questions about the Broker’s Bid is different from the person identified above, please provide the same information for the person responsible for answering questions about the Broker’s Bid.
Name:
Title:
E-mail Address:
Phone Number(s):
Emergency Number:
File details come from the government source that posted it. Updated .