Attachment 9 -Insurance Certification.pdf
PDF 220 KB Posted
- Attached to
- Asbestos Abatement B806, RVKQ 26-0008
- Solicitation number
- FA6670-26-Q-0008
About this file
This is a federal contract insurance acknowledgement and certification form for contract number FA6670-26-X-00XX. The document serves as a binding agreement between the contractor and the U.S. Air Force regarding insurance requirements and compliance obligations throughout the contract performance period.
The contractor certifies five key compliance commitments: obtaining and maintaining insurance coverage in the types and amounts specified in the contract; ensuring all required insurance policies contain endorsements protecting the government's interests with a minimum 30-day cancellation notice requirement; maintaining New York State Workmen's Compensation Insurance or an equivalent reciprocal agreement with another state for the entire performance period including any modifications or extensions; ensuring all subcontractors maintain current insurance certifications meeting contract requirements; and acknowledging the agreement is legally binding and enforceable. The form requires contractor information including authorized signature, typed name and title, street address, and city/state/zip. The contractor must also provide the insurance company name, street address, city/state/zip, agent contact information, and policy number. The Contracting Officer accepts and incorporates the agreement into the contract in compliance with FAR 52.228-5 or 52.228-8 as applicable. The document is signed by the Contracting Officer from 914 MSG/PK (914th Maintenance Squadron/Plans and Scheduling).
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Text version
ACKNOWLEDGEMENT, AGREEMENT AND CERTIFICATION OF COMPLIANCE
WITH CONTRACT INSURANCE REQUIREMENTS
CONTRACT NUMBER FA6670-26-X-00XX
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 New York State 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
, MSG PK
File details come from the government source that posted it. Updated .