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 form required by Volusia County, Florida for ITB 26-B-39IF, the Florida Shores Boulevard Vehicular Beach Access Ramp Project. The affidavit serves as a sworn statement by the insurance broker for the contract bidder, certifying that good-faith efforts were made to obtain Installation Floater or Builder's Risk insurance with Flood coverage extensions that include coverage for flood damage resulting from storm surge caused by named and unnamed storms for beach and intracoastal waterway construction projects. The affidavit requires the insurance broker to identify three insurance companies contacted and confirm that all three declined to provide the required coverage. The form must be notarized and signed by both the affiant and witnesses, establishing a mechanism for bidders to demonstrate compliance with insurance requirements when standard coverage is unavailable in the market.
This affidavit document functions as a conditional waiver or alternative compliance demonstration when bidders cannot obtain the specifically mandated insurance coverage due to market unavailability. By requiring documented contact with three insurance providers and their explicit refusal to provide coverage, the county acknowledges the challenging insurance environment for coastal construction projects while maintaining documentation standards. The affidavit must be completed and returned as part of the bidding process, with notarization required to validate the sworn statements and good-faith efforts undertaken by the bidder's insurance broker.
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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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