Exhibit_L_-_Installation_Floater_Affidavit_26-B-39IF.docx
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- Solicitation number
- 26-B-39IF
- Issued by
- Volusia County, Florida
About this file
This is an Installation Floater Affidavit for ITB 26-B-39IF, the Florida Shores Boulevard Vehicular Beach Access Ramp Project in Florida. The affidavit documents the insurance broker's certification that the contract bidder has made good-faith efforts to obtain required insurance coverage. Specifically, the affidavit confirms that the bidder contacted three insurance companies to secure Installation Floater or Builder's Risk insurance policies with Flood coverage extensions, including coverage for flood damage resulting from storm surge caused by named and unnamed storms, as required by Exhibit A of the ITB for this beach and intracoastal waterway construction project.
The affidavit serves as documentation that the three contacted insurance companies were unable to provide the required Installation Floater or Builder's Risk insurance coverage with Flood coverage extension for the project. This document must be notarized and signed before a notary public, with witness signatures required, and includes spaces for the affiant (insurance broker), contract bidder name, and the three insurance companies contacted. The affidavit provides evidence of the bidder's diligent attempt to comply with insurance requirements when such coverage is unavailable in the market, which may affect the bidder's ability to meet the contract's insurance specifications.
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Text version
STATE OF
COUNTY OF
BEFORE ME, the undersigned authority, authorized in the state and county aforesaid to take acknowledgements, personally appeared ______________ (affiant), who after being duly sworn deposes and says:
Affiant is the Insurance Broker for _______________ (Contract Bidder). Contract Bidder placed a bid for ITB 26-B-39IF for Florida Shores Boulevard Vehicular Beach Access Ramp Project. ITB 26-B-39IF requires the Contract Bidder to attain the insurance contained in Exhibit A of ITB 26-B-39IF which includes a requirement for either an Installation Floater or Builder’s Risk insurance policy with a Flood coverage extension which includes coverage for Flood resulting from storm surge caused by named and unnamed storms for a beach or intracoastal waterway construction project. On behalf of the Contract Bidder, I contacted the following three (3) insurance companies to attain Installation Floater and Builder’s Risk insurance coverage with a Flood coverage extension for ITB 26-B-39IF:
1.________________________________________________________________
2.________________________________________________________________
3.________________________________________________________________.
The three (3) companies listed above informed me that they are not able to provide Installation and Builder’s Risk insurance coverage policy with a Flood coverage extension to the Contract Bidder in support of ITB 26-B-39IF.
SIGNED, SEALED AND DELIVERED
IN THE PRESENCE OF:
Witness signature Print Name:
(Print Name)
Witness signature
(Print Name)
The foregoing instrument was acknowledged before me by means of [__]physical presence or [ ] online notarization this ____ day of _________, 202_, by ____________ ___who is personally known and/or produced ___________________ as identification and who being duly sworn, deposes and says that the aforementioned is true and correct to his or her best knowledge.
Notary Public signature
Print Name
My commission expires:
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