Attachment_11__-__Insurance_Certificate.pdf

Attachment 11 Solicitation No: FA4830-17-R-S001

Title: Unit Support Services II (USS2)

CERTIFICATE OF COMPLIANCE WITH INSURANCE REQUIREMENTS

CONTRACT NO. ________________

The undersigned Contractor hereby acknowledges that he/she has read and understands the insurance requirements specified in this contract and hereby agrees (1) that such insurance will be maintained in at least the amounts and types specified in this contract and during any modifications and/or time extensions granted thereto; (2) that the policies evidencing required insurance shall contain an indorsement to the effect that any cancellation or any material change adversely affecting the Government’s interest shall not be effective for such period as the laws of the State in which this contract is to be performed prescribe or until 30 days after the insurer or the Contractor gives written notice to the Contracting Officer, whichever period is longer; (3) that Georgia Workmen’s Compensation Insurance, or letter of reciprocal agreement with another state, shall be maintained on this contract for and during the entire performance period and for any modifications and/or time extensions granted thereto; and (4) that a copy of all subcontractors’ proofs of required insurance shall be maintained and shall be made available to the Contracting Officer upon request. This agreement shall become a part of the above referenced contract file.

INSURANCE COMPANY (S):

(Name(s)) (Telephone No.)

CONTRACTOR:

(Name)

(Address)

(Authorized Signature) (Date)

(Typed Name and Title)

Verified by V. Houston - 15 Dec 2016