Exhibit B _ Certificate of Insurance and Mino.docx
DOCX document 32 KB Posted
- Solicitation number
- PE-54300-RFQC-2025-000000054
- Issued by
- Cobb County, Georgia
About this file
This is a Certificate of Insurance and Minority Status form (Exhibit B) for Gordon State College's Student Activity & Recreation Center project (PPV-89-1201). The document is designed to collect insurance and minority business status information from firms applying for the project management RFQ/RFP.
The form requires applicants to provide their professional liability insurance carrier information, including coverage amount and deductible per claim. It also includes fields for firms to indicate their minority business status (MBE, WBE, or Other) for both the applying firm and any associated firms. The document must be notarized with a signature, date, and notary seal.
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Other files
| File | Type | Posted |
|---|---|---|
| Addendum 1.docx | DOCX document | |
| Exhibit E _ Contractor Affidavit.docx | DOCX document | |
| Exhibit G _ Proposers Disclosure Statement.doc | DOC document | |
| Addendum 3.docx | DOCX document | |
| Exhibit F _ Project Cost Matrix.xlsx | XLSX spreadsheet | |
| 777_25_125 KSU Campus Alta Survey_SUE and GIS.docx | DOCX document | |
| Exhibit A _ Certification Form.docx | DOCX document | |
| Exhibit D _ Consultant Fee Proposal Sample.docx | DOCX document | |
| Addendum 5.docx | DOCX document | |
| Addendum 2.docx | DOCX document | |
| Addendum 4.docx | DOCX document |
Show all 11
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Text version
Exhibit B
CERTIFICATE OF INSURANCE AND MINORITY STATUS
INSURANCE:
Name of Applying Firm: _____________________________________________________
State the name and address of Applying Firm’s professional liability insurance carrier ____________________________________________________________________
Amount of coverage - $ ______________________________________________________
Amount of deductible per claim: $ ______________________________________________
MINORITY STATUS:
Indicate the status of the Applying Firm and Associated Firm, if applicable :
APPLYING FIRM: MBE_____ WBE_____ OTHER __________
ASSOCIATED FIRM: MBE_____ WBE_____ OTHER___________
| ______________________________________ | |
| Signature |
Sworn and subscribed before me This ____day of ________, 20_____
NOTARY PUBLIC
NOTARY SEAL
My Commission expires: _________________
Gordon State College PPV-89-1201, Student Activity & Rec Ctr., PM RFQ/RFP
File details come from the government source that posted it. Updated .