Submittal Form 3 - Insurance and Contract Attestation Form. fillable.pdf

Insurance and Contract Certification Larimer County is diligent about enforcing insurance requirements listed in all contracts. This diligence means the County expects all applicants to acknowledge and attest to the following statements.

It is recommended that you confirm with your insurance carrier before submitting your application that your company can meet the insurance requirements published in the solicitation. All Larimer County contracts require the vendor to maintain the defined insurance requirements throughout the contract term; these coverages are purchased at the applicant’s expense. The County’s insurance requirements may necessitate adding or increasing coverage or limits, and those changes may impact pricing for the proposed project. These costs must be included in pricing at the time of submission and will not be permitted to be added later.

____(initial) I certify, on behalf of the applicant identified below, that I have reviewed the Insurance Requirements for this solicitation.

____(initial) I certify that the applicant currently meets or will obtain all the Insurance Requirements provided in this solicitation before entering a Contract with the County.

____(initial) I understand, upon Notice of Award, I will be required to submit a valid Certificate of Insurance meeting the Insurance Requirements published in this solicitation. I understand a valid Certificate of Insurance must be received by Larimer County within ten (10) business days of the Notice of Award and must include Larimer County as Additional Insured and Certificate Holder.

____(initial) I further hereby certify, I have read the sample contract attached to the solicitation and understand the terms and provisions contained in that contract, and it is the applicant’s intent to comply with each and every term and provision contained in the sample contract and propose no modifications to the sample contract except as follows (There will be NO modifications to insurance provisions except in regard to the waiver of Workers’ Compensation for sole proprietors and personal auto in place of business auto for those who use personal autos for business use):

____(initial) I understand that the modifications stated above, if any, are offered for discussion purposes only, and Larimer County reserves the right to accept, reject, or further negotiate all proposed modifications to the sample contract.

Agency/Name:________________________________________________________________

Printed Name (Authorized Signer):________________________________________________

Signature of Authorized Signer:___________________________________________________

Insurance and Contract Certification