Notification of Compliance with Contract Insurance Requirements Pittsburgh.pdf
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- Attached to
- Storage Aid System Pittsburgh ANGB
- Solicitation number
- FA860426RB011
About this file
This is a notification and acknowledgment form for contractor compliance with federal contract insurance requirements under contract FA8604-26-R-B011.
The contractor must acknowledge understanding and maintain insurance coverage in accordance with FAR 28.307-2, specifying minimum amounts and types throughout the contract performance period and any modifications or time extensions. Required insurance policies must include endorsements protecting the Government's interest, ensuring that policy cancellations or material adverse changes cannot take effect until either state law requirements are satisfied or thirty calendar days after written notice is provided to the Contracting Officer, whichever is longer. The contractor must maintain Workers' Compensation Insurance for the designated state or provide a letter of reciprocal agreement with another state for the entire performance period and any contract extensions. Additionally, the contractor must maintain copies of all subcontractors' proofs of required insurance and make them available to the Contracting Officer upon request. The form functions as a legally binding and enforceable agreement incorporated into the subject contract.
The document is a template requiring completion with insurance company details (name, address, policy number, and telephone number) and contractor information (company name and address), along with signature and date fields for the authorized contractor representative.
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Text version
Notification of Compliance with Contract Insurance Requirements
The undersigned Contractor hereby acknowledges that he/she has read and understands the insurance requirements specified in this contract and hereby provides notification (1) that such insurance shall be maintained in at least the amounts and types as stated in FAR 28.307-2 and during any modifications and/or time extensions granted thereto; (2) that the required insurance policies shall contain an endorsement to the effect that any cancellation of material changes 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 thirty (30) calendar days after the insurer or contractor gives written notice to the Contracting Officer, whichever period is longer; (3) that _____________ (state) Workers' 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 be a part of subject contract and shall be legally binding and enforceable at law.
INSURANCE COMPANY(S):
Name:
Address:
Policy #:
Telephone #:
CONTRACTOR:
Company Name:
Address:
(Typed Name and Title) (Date)
(Authorized Signature)
FA8604-26-R-B011 Attachment 12 Page 1 of 1
File details come from the government source that posted it. Updated .