EXHIBIT C - Insurance Carriers or Agents Acknowledgment Form.docx
DOCX document 47 KB Posted
- Solicitation number
- 1669A
- Issued by
- Suffolk County, New York
About this file
Exhibit C is an Insurance Carriers or Agents Acknowledgment Form for the Suffolk County Water Authority (SCWA), related to a Radio Frequency (RF) Consulting Services contract for their SCADA Communications Network. The document requires insurance carriers and bidding agents to review and confirm compliance with specific insurance requirements for a contract opportunity (RFP No. 1669A), with electronic proposal submissions due by December 16, 2025, at 11:00 a.m. EST. A mandatory pre-bid conference is scheduled for November 19, 2025, at 10:00 a.m. at the SCWA Production Control building in Bayshore, NY, and failure to attend will result in bid disqualification.
The form mandates that insurance agents and bidders acknowledge their ability to provide various types of insurance coverage, including automobile liability, general liability, excess liability, worker's compensation, and professional liability insurance, among others. Bidders must confirm they have reviewed the insurance requirements and can procure the necessary coverage at no additional cost to SCWA. The contract opportunity specifically seeks an RF consultant to design and field test a new wireless communications network for SCWA's existing SCADA system throughout Suffolk County, with Disadvantaged Business Enterprises (DBEs) explicitly encouraged to participate. While specific budget details are not provided, the project represents a significant technology investment in municipal water infrastructure communication systems.
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Other files
| File | Type | Posted |
|---|---|---|
| EXHIBIT B - Affirmation of Understanding and Compliance.docx | DOCX document | |
| EXHIBIT D - Contact Information.docx | DOCX document | |
| Exhibit F - Proposer Acknowledgment Form.docx | DOCX document | |
| RFP 1669 - Appendix B - Combined Drawings.pdf | ||
| RFP 1669A - Appendix C - FCC Licenses.xlsx | XLSX spreadsheet | |
| Appendix A - Pump Stations.pdf | ||
| EXHIBIT A1 - SCWA Disclosure Form.docx | DOCX document | |
| EXHIBIT E - 1669A.docx | DOCX document | |
| RFP 1669A - Appendix A - Pump Station and Tank Database R1.xlsx | XLSX spreadsheet | |
| Request for Proposal.pdf | ||
| Subcontractor Insurance Agreement (If Applicable).docx | DOCX document | |
| Appendix A - Tanks and Towers.pdf | ||
| Exhibit A - Form of Offerer Disclosure.docx | DOCX document |
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Text version
EXHIBIT C
Insurance Carrier or Agent's Acknowledgement
Project Description: Contract No._______ – ________________________________________________________________
Your Insurance Carrier or Agent must complete the Form below. You must complete the Bidder's Acknowledgment. This Form shall be returned with the Bid submission.
Insurance Agent:
NAME OF FIRM
Address:
Email:
Fax No.: Phone No.:
Please review the SCWA insurance requirements contained in this Contract which are listed in the Instructions to Bidders. Confirm that you have read these specific requirements (pay particular attention to required limits) and that you are complying with them by placing a check in the appropriate box.
1. Automobile Liability
1. Material is Delivered by common carrier
1. General Liability
1. Excess Liability
1. Vendor’s Endorsement
1. Worker’s Compensation
1. Owners and Contractors Protection Liability (OCP)
1. Professional Liability Insurance
1. Builders Risk or Installation Coverage Floater
1. Crime
We have reviewed the insurance requirements set forth in the above proposed contract and are capable of providing such insurance to our insured in accordance with such requirements in the event the contract is awarded to our insured and provided our insured pays the appropriate premium.
Dated: Sign:
Authorized Insurance Agent or Representative
Print Name:
BIDDER'S ACKNOWLEDGMENT
The Bidder herein acknowledges that he/she has reviewed the insurance requirements within this Contract and has considered the costs, if any, of procuring the required insurance and will be able to supply the insurance required as per the Contract, if awarded to the Bidder, at no additional cost to the SCWA.
Sign:
Officer of Company Print Name
(Failure To Have This Form Properly Filled Out and Signed by The Insurance Agent as Well as The Bidder May Result in Your Bid Being Considered Non-Responsive.)
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