Exhibit B _ Certificate of Insurance _ Minori.docx
DOCX document 32 KB Posted
- Solicitation number
- PE-50300-RFP-2025-000000172
- Issued by
- Fulton 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 a blank form requiring applicants to provide their firm name, professional liability insurance details including carrier information, coverage amount, and deductible per claim.
The form includes a section for declaring minority status where applying firms and associated firms must indicate if they are MBE (Minority Business Enterprise), WBE (Women Business Enterprise), or Other. The document requires notarization, including a signature, notary seal, and commission expiration date.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Addendum__1 for release 01_06_2025.pdf | ||
| Exhibit D _ DP Fee Proposal.doc | DOC document | |
| 0251_2025 RFQP_DP_Final.pdf | ||
| Exhibit A _ Certification Form.docx | DOCX document | |
| Exhibit H _ Sample Form of AIA Contract.pdf | ||
| Exhibit E _ Contractor Affidavit.docx | DOCX document | |
| Exhibit C _ Team Composition.docx | DOCX document | |
| Exhibit F _ Proposer_s Disclosure Statement.doc | DOC document | |
| Exhibit G _ Project Schedule.pdf |
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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 .