INSURANCECERT.doc

ACKNOWLEDGEMENT, AGREEMENT AND CERTIFICATION OF COMPLIANCE

WITH CONTRACT INSURANCE REQUIREMENTS

CONTRACT FA8501-13-C-0007

The undersigned Contractor hereby acknowledges that he/she has read and understands the insurance requirements specified in this contract, and hereby certifies; 1) that such insurance has been obtained and agrees that said insurance will be maintained in at least the amount and types specified in this contract and during any modifications and/or time extensions granted thereto; 2) that these required insurance policies will each contain an endorsement to the effect that cancellation of any material change to the insurance policies adversely affecting the interest of the government shall not be effective for such period as may be prescribed by the laws of the State in which this contract is to be performed and in no event less than thirty (30) days after written notice thereof has been given to the Contracting Officer; 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 and during any modifications and/or time extensions granted thereto; 4) where shall ensure that each subcontractor possesses current certification of insurance satisfying the contract requirements; and 5) that this agreement shall become a part of the above referenced contract and shall be legally binding and enforceable by Law.

(CONTRACTOR)

(INSURANCE COMPANY NAME)

(STREET ADDRESS)

(STREET ADDRESS)

(CITY, STATE, ZIP)

(CITY, STATE, ZIP)

(AUTHORIZED SIGNATURE, DATE) (AGENT, TELEPHONE NUMBER)

(TYPED NAME AND TITLE)

(POLICY NUMBER)

ACCEPTANCE

The undersigned Contracting Officer, on behalf of the United Sates of America, hereby accepts the above Agreement and Certification and hereby incorporates the above Agreement into the above referenced contract in full text in compliance with FAR 52.228-5 or 52.228-8, as applicable.

UNITED STATES OF AMERICA

DATE:_____________________

(CONTRACTING OFFICER/78 CONS/PKC)