ITB 6924 Corrosion Inhibitor Contract

Location: Tennessee
Posted: Sep 11, 2026
Due: Sep 23, 2026
Agency: City of Johnson City
Type of Government: State & Local
Category:
  • 68 - Chemicals and Chemical Products
Publication URL: To access bid details, please log in.


Submittals due by September 23rd, 2026 at 1:30PM ET.


Attached Document :


ITB 6924 Corrosion Inhibitor Contract.pdf

Attachment Preview

Corrosion Inhibitor as per the attached specifications which are an integral part of this bid. Calciquest Liquid, AquaMagk-5, Aquadene SK-7870 or approved equal*. Cost figures to be shown below. Specify Product Proposed: ___________________________________ Annual projected cost to be based on an average flow of 13 MGD with a calculated dosage based on the following**: pH - 7.0 Hardness - 50 mg/l Alkalanity - 50 mg/l Iron - 0.01 mg/l Manganese - 0.001 mg/l ** Calculated Dosage(s): _______/mg/l (ortho) ______mg/l (poly) ____________/mg/l (total) % Total phosphate: , Lbs of Phosphate/Gallon: ___________ Gallons/Year of Product _________ ________________ Cost/Gallon: $___________ Cost/MG: $______________ Cost/Year: $__________________ SEE ATTACHED FOR BID SUBMITTAL REQUIREMENTS
Solicitations will be opened publicly via a simultaneous virtual and in-person meeting. Join Zoom Meeting: ITB 6924 Corrosion Inhibitor Contract Virtual Bid Opening; Meeting ID: 865 7739 2847 Passcode: 029229. If you do not have access to a webcam, or you have no audio with your system, you may call this number to join: (646) 518-9805. For any issues accessing the zoom web meeting, please call 423.975.2715 for direct assistance.

INVITATION TO BID
CITY OF JOHNSON CITY, TENNESSEE
PURCHASING DEPARTMENT
WWW.JOHNSONCITYTN.ORG/PURCHASING 423/975-2711
Bid Name / Number CORROSION INHIBITOR CONTRACT /ITB #6924
Due Day / Date / Time Wednesday/Sept. 23, 2026 / 1:30 PM ET (at which time it will be opened publicly)
Bid Location / Mail Address Johnson City Purchasing Department, Debbie Dillon-Director,
209 Water Street, Johnson City, TN 37601
Bid Contact / Telephone Aaron Mullins, amullins@johnsoncitytn.org or purchasing@johnsoncitytn.org
Bid Issue Date September 10, 2026
Project Location Watauga Water Treatment Plant, 203 Riverview Dr. Johnson City, TN 37601
FOB Destination, freight prepaid and allowed - Johnson City, TN
Payment Terms Net 30
Anticipated Award Date: October 14, 2026
Bidder is responsible for completing the remaining portion of this bid document
DESCRIPTION
Corrosion Inhibitor as per the attached specifications which are an integral part of this bid. Calciquest Liquid,
AquaMagk-5, Aquadene SK-7870 or approved equal*. Cost figures to be shown below.
Specify Product Proposed: ___________________________________
Annual projected cost to be based on an average flow of 13 MGD with a calculated dosage based on the
following**:
pH - 7.0 Hardness - 50 mg/l Alkalanity - 50 mg/l
Iron - 0.01 mg/l Manganese - 0.001 mg/l
** Calculated Dosage(s): _______/mg/l (ortho) ______mg/l (poly) ____________/mg/l (total)
% Total phosphate: , Lbs of Phosphate/Gallon: ___________ Gallons/Year of Product _________
________________
Cost/Gallon: $___________ Cost/MG: $______________ Cost/Year: $__________________
SEE ATTACHED FOR BID SUBMITTAL REQUIREMENTS
Solicitations will be opened publicly via a simultaneous virtual and in-person meeting.
Join Zoom Meeting: ITB 6924 Corrosion Inhibitor Contract Virtual Bid Opening; Meeting ID: 865 7739 2847
Passcode: 029229. If you do not have access to a webcam, or you have no audio with your system, you may
call this number to join: (646) 518-9805. For any issues accessing the zoom web meeting, please call 423.975.2715
for direct assistance.
Bidder's Reminder: Bid to be signed by authorized company representative; Verify prices, extensions and total as correct
By signing this document, the undersigned hereby agrees to the prices and all other terms and conditions, including the attached Sealed Solicitation
General Terms & Conditions and the City's Requirements for Bids, Requests for Proposals, and Contracts Between the City of Johnson City and Other
Parties and the Requirements of the Iran Divestment Act and Non-Boycott of Israel Act (Sealed Solicitations General Terms & Conditions #16 & #19)
contained in this bid and associated documents relating to this bid and will furnish items as specified if this bid is accepted. By submission of this bid,
each bidder and each person signing on behalf of any bidder certifies, and in the case of a joint bid each party thereto certifies as to its own organization,
under penalty of perjury, that to the best of its knowledge and belief that each bidder complies pursuant to T.C.A. 12-12-106 & T.C.A. 12-4-119.
SUBMITTAL INSTRUCTIONS: Firm Name______________________________________________
Submit electronically per link below or place
signed bid response in a sealed envelope By________________________________________________
plainly identified on the outside with vendor PRINTED & SIGNED
name and bid name and number. Vendor Address_______________________________________________
responsible for delivery to Johnson City
Purchasing Dept., Debbie Dillon- Director, 209 ________________________________________________
Water Street, Johnson City, TN 37601 on or
before the bid opening date and time. Telephone_____________________________________________
ELECTRONIC RESPONSES: CLICK HERE E-Mail________________________________________________
THIS SHEET MUST BE SIGNED AND RETURNED WITH BID PACKAGE TO BE CONSIDERED

ITB# 6924
CORROSION INHIBITOR
BIDDER INSTRUCTIONS
PRODUCT APPROVAL
The products listed are preferred and have been lab tested and approved for use in
our system. If offering other than as specified, a product test and additional
chemical analyses will be required, prior to bid award.
DOSAGE FORMULA
**Provide the formula used to calculate effective dosage(s) as submitted on bid cover
sheet. Include a brief scientific explanation. If you require additional parameters,
please contact Aaron Mullins at (423)975-2623.
CONTRACT PERIOD
This contract shall be for a three year period, renewable annually if all terms,
conditions and prices remain unchanged and both parties are in agreement. Prices
contained herein are to be firm for the terms of the contract. The City reserves the
right to re-bid at the end of any one year period, or renew for additional years.
PRODUCT QUALITY
If, during the contract period, a determination is made that the product is not
sufficiently reducing rates to desired levels, the J.C.Water Department reserves the
right to discontinue usage.
BID AWARD
PAST PERFORMANCE OF VENDOR WILL BE A CONSIDERATION IN
THE BID AWARD ALONG WITH PRODUCT CHARACTERISTICS AND
DOSAGES REQUIRED.

ITB# 6924
CORROSION CONTROL
SPECIFICATION SHEET
Note: Vendor must complete and return this form for the bid to be considered responsive.
A check mark ( shall be placed in the areas of specification agreement. Variances must
be clearly identified in the bidder's equipment column. Failure to comply with any part of
the specifications will not remove that bid from consideration but will indicate a variance
on which the City alone will determine the importance to the overall performance of the
item and suitability for the intended purpose. Products shall be new, unused and of the
Manufacturer's latest production. Any omission from the specifications shall not relieve
the vendor from the responsibility of furnishing corrosion inhibitor ready for use.
City Specifications Vendor's Compliance
Product proposed: (please specify) ________________
Standards and Approvals:
Product shall comply with all applicable EPA and AWWA ________________
requirements and approved by the National Sanitation Foundation.
Product must be tested and certified against the ANSI/NSF ________________
Standard 60 or 61 for use in potable water.
Requirements:
Product must result in effectively reducing the corrosion ________________
rate in the distribution system as measured in mils per year.
The successful bidder must furnish corrosion coupons of ________________
cold roll mild steel and corrosion coupon racks to be
installed as designated by the Water Department.
The successful bidder must provide any necessary technical ________________
assistance for installation of the coupon racks and coupons.
Corrosion coupons shall be evaluated at 60-90 day intervals. ________________
A minimum of three coupon racks complete with miscellaneous ________________
valves, fittings, flow control devices, etc. shall be supplied to
the J. C. Water Department, at no charge.
Two of the above coupon racks will be installed in the ________________
distribution system and one will be installed at the
Water Treatment Plant.
Company Name:____________________________________
Page 1 of 3

City Specifications Vendor's Compliance
Each coupon rack shall accommodate a minimum of two cold ________________
roll mild steel corrosion coupons.
A minimum of two mild steel corrosion coupons shall be inserted ________________
into each coupon rack assembly at all times during the contract period.
The successful bidder shall make provision to have new ________________
pre-weighed corrosion coupons sent to the J.C.Water Department and
removed corrosion coupons sent by the J.C.Water Department from/to
an independent laboratory selected by the vendor and approved
by the J.C.Water Department.
A report of the corrosion coupon analysis shall be supplied ________________
by the independent laboratory to the J.C.Water Department.
New corrosion coupons shall be handled only by the ________________
J.C.Water Department and the designated laboratory.
Corrosion coupons, racks and miscellaneous laboratory testing ________________
services provided as a part of this package shall be at no charge
to the J.C.Water Department. Coupon racks shall become
property of the J.C.Water Department.
Corrosion coupon racks and coupons shall be installed within ________________
thirty days of the contract award.
The achieved rate of corrosion must not exceed ten(10) mils per ________________
year (mild steel) as determined by averaging each of the 60-90 day results.
Product is to be a liquid and must be suitable to be fed with ________________
existing feeding equipment. Equipment supplied shall become the
property of the J.C.Water Department.
Product must be manufactured as a dry sodium based product. ________________
Product must contain only sodium compounds and cannot contain ________________
any free phosphoric acids or in-situ neutralized phosphoric acids.
Product will require no special handling. ________________
Product shall contain no soluble mineral or organic substance in ________________
quantities capable of producing adverse health effects upon those
consuming water that has been properly treated with this product.
Company Name: ____________________________________
Page 2 of 3

City Specifications Vendor's Compliance
Technical on-site assistance will be provided for a minimum of one _______________
day per month during the length of the contract.
Supplier shall inform the J.C.Water Department as to the type and _______________
method of analysis required to confirm proper product application rates.
Product shall contain NO ZINC. ________________
Deliveries:
Delivery shall be as needed with seven days notice. ________________
Product shall be shipped in bulk shipments of 3500-4000 gallons. ________________
BID SUBMITTALS:
A typical analysis sheet shall be furnished for each product(s) offered, with the return bid.
Information pertaining to the selected laboratory for the provision of corrosion coupons and
coupon analysis is to be attached to the return bid.
Bidders shall include with return bid, current safety data sheets (SDS) for
product(s) offered.
A minimum of three product references (current user's) shall be included with return bid.
Include the utilities name, address, telephone number and designated contact person.
COMPLETE AN RETURN WITH BID PACKAGE
Company Name: _____________________________________
Page 3 of 3

INSURANCE CHECKLIST
(W-S - Corrosive Inhibitor incl. delivery)
REQUIRED COVERAGE (marked by "x") MINIMUM LIMITS
X 1. Worker's Compensation (proprietor/partners/executive officers exclusion not allowed) . . . . . . . . . . . . . . Statutory limits of Tennessee
and Employer's Liability . . . . . . . . . . . . . . . . . . . . . . $100,000/accident, $100,000/disease, $500,000/disease policy limit
X 2. Commercial General Liability (including Premises/Operations) . . . . . . . . . . . $1,000,000 CSL BI/PD each occurrence, $1 Million
annual aggregate
X 3. Automobile Liability & Owned/Hired/Non-Owned Vehicles . . . . . . . . . $500,000 BI/PD each accident, Uninsured Motorist
X 4. Independent Contractors . . . . . . . . . . . . . . . . . . . . $1,000,000 CSL BI/PD each occurrence, $1 Million annual aggregate
X 5. Products/Completed Operations . . . . . . . . . . . . . . $1,000,000 CSL BI/PD each occurrence, $1 Million annual aggregate
X 6. Contractual Liability . . . . . . . . . . . . . . . . . . . . . . . . $1,000,000 CSL BI/PD each occurrence, $1 Million annual aggregate
X 7. Personal and Advertising Injury Liability . . . . . . . . . . . . . . . . . . . . . $1,000,000 each offense, $1 Million annual aggregate
8. Umbrella Liability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1 Million Bodily Injury, Property Damage and Personal Injury
9. Per Project Aggregate
10. Professional Liability
a. Architects and Engineers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1 Million per occurrence/claim
b. Asbestos Removal Liability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$2 Million per occurrence/claim
c. Medical Malpractice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1 Million per occurrence/claim
d. Medical Professional Liability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1 Million per occurrence/claim
11. Miscellaneous E & O . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1 Million per occurrence/claim
12. Motor Carrier Act End. (MCS-90) . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1 Million BI/PD each accident, Uninsured Motorist
13. Motor Cargo Insurance
14. Garage Liability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1 Million Bodily Injury, Property Damage per occurrence
15. Garagekeepers Liability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $500,000 Comprehensive, $500,000 Collision
16. Inland Marine-Bailee's Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $_______________
17. Moving and Rigging Floater . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Endorsement to CGL
18. Dishonesty Bond . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $_______________
19. Builder's Risk/Installation Floater . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Provide coverage in the full amount of contract
20. XCU Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Endorsement to CGL
X 21. Carrier Rating shall be Best's Rating of B++V or better or its equivalent
X 22. Notice of cancellation, non-renewal or material change in coverage shall be provided to City at least 30 days prior to
action. Worker's Compensation and/or non-payment of premium - notification may be 10 days prior to action.
X 23. The City of Johnson City shall be named as Additional Insured on all policies except Worker's Compensation and
Professional Liability. Policies must be endorsed to incl. on-going & completed operations;
must submit copy of endorsement(s). (Cert. Holder: City of Johnson City, Attn: Purchasing, P.O. Box 2150, Johnson
City, TN 37605. Email: purchasing@johnsoncitytn.org.)
X 24. Certificate of Insurance shall show project number or other contract identifier used by the City.
X 25. OTHER INSURANCE REQUIRED: _________Pollution Liability - $1,000,000___________________________________
INSURANCE AGENT'S STATEMENT:
I have reviewed the above requirements with the bidder named below. The bidder has coverage with this agency for all of the
areas marked with the exception of the following numbers:
_____ _____ _____ _____ _____ _____ Comments: _______________________________________________
Is Professional Liability excluded under General Liability? Yes_____ No_____
Is Contractual Liability excluded under Comm. General Liability? Yes_____ No_____
Is Independent Contractors excluded under Comm. General Liability? Yes_____ No_____
Is XCU coverage excluded? Yes____ No _____
Carrier ratings: Insurer A________; Insurer B________; Insurer C________; Insurer D________
AGENCY NAME: ________________________________ AUTHORIZED SIGNATURE: ______________________________
Date: _____________________________
VENDOR'S STATEMENT:
I have reviewed the above requirements with my insurance agent(s) and, if awarded a contract, will provide all coverage marked.
VENDOR'S NAME: ______________________________ AUTHORIZED SIGNATURE: ___________________________
Date: _____________________________ AUTHORIZED (Printed):
Bid Number: ________________
Bid or Project Name: _____________________________________________
This form and the General Insurance Appendix must be signed and returned with the bid package (if
applicable). The Certificate of Insurance must be provided to Purchasing prior to contract award.

GENERAL INSURANCE APPENDIX
The General Insurance Appendix is included in every solicitation requiring insurance. The
general requirements of the contract form are supplemented by items checked on the
Insurance Checklist that identify specific requirements for the bid or project.
INSURANCE
Review this section carefully with your insurance agent or broker prior to submitting a bid or
proposal. See Insurance Checklist (part of the Bid Forms) for specific coverage applicable to
this contract. The term "Contract" as used in this section shall mean the Agreement covering
the work that is entered into between the City of Johnson City, Tennessee and the Vendor.
1. General Insurance Requirements:
1.1 The Vendor shall not start work under this contract until the Vendor has obtained at its
own expense all of the insurance called for hereunder and such insurance has been approved
by the City; nor shall the Vendor allow any subcontractor to start work on any subcontract
until all insurance required of the subcontractor has been so obtained and approved by the
Vendor. Approval of insurance required of the Vendor will be granted only after submission
to the Director of Purchasing of original, signed Certificate(s) of Insurance, General Insurance
Appendix, and Insurance Checklist or, alternately, at the City's request, certified copies of the
required insurance policies.
1.2 No acceptance and/or approval of any insurance by the City shall be construed as
relieving or excusing the Vendor, or the surety, or its bond, from any liability or obligation
imposed upon either or both of them by the provisions of the Contract Documents.
1.3 The City of Johnson City (including its elected and appointed officials, agents, and
employees) is to be named as an additional insured under all coverage except
Worker's Compensation and Professional Liability and the Certificate of Insurance or
the certified policy, if requested, must so state. Coverage afforded under this paragraph
shall be primary as respects the City, its elected and appointed officials, agents and
employees. The following definition of the term "City" applies to all policies issued under the
contract:
"The City of Johnson City, Tennessee together with all of its various
departments, bureaus, and agencies, as well as any affiliated or subsidiary
board, committee, or authority, including but not limited to the City of Johnson
City, Dept. of Education (A.K.A "Johnson City Schools")."
1.4 The Vendor shall provide insurance as specified in the Insurance Checklist contained in
this document. In the event that Vendor obtains insurance coverage that is broader than the
minimum required by this Agreement, this Agreement shall be deemed to require the broader
coverage, including but not limited to any greater limits and any excess or umbrella
coverages.
Insurance Guide - Prof. Lia.
Revised 3/17/2026

1.5 The Vendor covenants to save, defend, hold harmless and indemnify the City of Johnson
City, Tennessee together with its various departments, elected or appointed officials,
employees, officers, counsel, agents, and any and all other persons or entities acting on
behalf of the same (collectively the City) from and against any and all claims of any sort based
upon any theory of liability whatsoever, for any and all harm, loss, damage, injury, cost
(including court cost and attorney fees) charges, or other liability of any nature whatsoever,
however caused, resulting from or arising out of or in any way connected with the Vendors
performance or non-performance of the terms of the contract documents or its obligations
under the contract based upon any theory of liability whatsoever, including claims brought by
third persons, and further covenants to discharge all of the aforesaid persons and entities and
forever hold them harmless from the same. The foregoing obligation to indemnify and defend
shall continue in full force and effect after the aforesaid Vendor completes all of the work
required under the contract, until such time as the applicable statutes of limitation or repose
have expired.
1.6 The Vendor shall be responsible for the work performed under the Contract Documents
and every part thereof, and for all materials, tools, equipment, appliances, and property of
any description used in connection with the work. The Vendor assumes all risks for direct
and indirect damage or injury to the property or persons used or employed on or in connection
with the work contracted for, and of all damage or injury to any person or property wherever
located, resulting from any action, omission, commission or operation under the Contract, or
in connection in any way whatsoever with the contracted work, until final acceptance of the
work by the City.
1.7 Insurance coverage required in these specifications shall be in force throughout the
Contract Term. If the Vendor fails to provide acceptable evidence of current insurance
within ten days of written notice at any time during the Contract Term, the City shall have
absolute right to terminate the Contract without any further obligation to the Vendor and the
Vendor shall be liable to the City for the entire additional cost of procuring performance by
another vendor and the cost of performing the incomplete portion of the Contract at time of
termination. Vendor is required to provide the City with notice of cancellation, non-renewal,
or material change in coverage at least thirty (30) days prior to cancellation, non-renewal, or
material change in coverage."
1.8 Contractual and other liability insurance provided under this Contract shall not contain a
supervision, inspection or engineering services exclusion that would preclude the City from
supervising or inspecting the project as to the end result. The Vendor shall assume all on-
the-job responsibilities as to the control of persons directly employed by it and of the
subcontractors and any persons employed by the subcontractor.
1.9 Nothing contained in the specifications shall be construed as creating any contractual
relationship between any subcontractor and the City. The Vendor shall be as fully responsible
to the City for acts and omissions of the subcontractor and of persons employed by them as
it is for acts and omissions of persons directly employed by the Vendor.
1.10 Precaution shall be exercised by the Vendor at all times for the protection of persons
(including employees) and property. All existing structures, utilities, roads, services, trees
and shrubbery shall be protected against damage or interruption of service at all times by the
Vendor and its subcontractors during the term of the Contract, and the Vendor shall be held
responsible for any damage to property occurring by reason of its operation on the property.
Insurance Guide - Prof. Lia.
Revised 3/17/2026

1.11 If a Vendor cannot meet the insurance requirements contained in a bid, proposal, or
project description, alternate insurance coverage may be considered. Written requests for
consideration of alternate coverage must be received by the Director of Purchasing at least
ten working days prior to the date set for receipt of bids or proposals. If the City denies the
request for alternate coverage, the specified coverage will be required to be submitted. If the
City permits alternate coverage, an amendment to the Insurance Requirement will be
prepared and distributed prior to the time and date set for receipt of bids or proposals.
1.12 All required insurance coverage must be acquired from insurers authorized to do
business in the State of Tennessee, and acceptable to the City. The insurers must also have
policyholders' rating of "B++" or better, and a financial size of "Class V" or better in the latest
edition of Best's Insurance Reports, unless the City grants specific approval for an exception
in the same manner as described in 1.11 above.
1.13 The City may consider deductible amounts as part of its review of financial stability. The
Vendor shall assume all deductibles.
2. Vendor's Insurance - Occurrence Basis:
2.1 The Vendor shall purchase the following insurance coverage, including the terms,
provisions and limits shown in the Checklist:
Commercial General Liability - The Commercial General Liability policy shall include
any or all of the following as indicated on the Checklist:
i. General aggregate limit is to apply per project;
ii. Premises/Operations;
iii. Action of Independent Vendors;
iv. Contractual Liability including protection for the Vendor from
claims arising out of liability assumed under this contract;
v. Personal Injury Liability including coverage for offenses related
to employment;
vi. Explosion, Collapse, or Underground (XCU) hazards;
vii. Pollution Liability.
Business Automobile Liability including coverage for any owned, hired, or non-owned
motor vehicles, Uninsured Motorists insurance, and Automobile Contractual Liability.
Worker's Compensation - statutory benefits as required by the State of Tennessee, or
other laws as required by labor union agreements, including standard Other States
coverage; Employers' Liability coverage.
Insurance Guide - Prof. Lia.
Revised 3/17/2026

3. Commercial General or other Liability Insurance - Claims-made Basis:
If Commercial General or other liability insurance purchased by the Vendor has been issued
on a claims-made basis, the Vendor must comply with the following additional conditions.
The limits of liability and the extensions to be included as described in the Checklist remain
the same. The Vendor must either:
i. Agree to provide certificates of insurance evidencing the above
coverage for a period of three years for Professional Liability; two years
for CGL and other Liability, after final payment for the contract. Such
certificates shall evidence a retroactive date, no later than the beginning
of the Vendors or subcontractors work under this contract, or
ii. Purchase an extended (minimum three years for Professional Liability;
two years for CGL and other Liability) reporting period endorsement for
the policy or policies in force during the term of this contract and
evidence the purchase of this extended reporting period endorsement
by means of a certificate of insurance or a copy of the endorsement
itself.
4. Alternative Coverage (Self Insurance)
Notwithstanding any of the above, the Vendor may satisfy its obligations under this section
by means of self-insurance for all or any part of the insurance required, provided that the
alternative coverage is acceptable to the City.
5. Limits of Liability Coverage
Specific limits of liability coverage on the Insurance Checklist may be adjusted according to
project risk if the adjustment is deemed appropriate and the amended amount is approved by
the City Manager.
6. Verification of Compliance
I have read this General Insurance Appendix and agree to all the terms and conditions
contained therein.
Vendor's Name: ____________________________________
EIN or SSN: ____________________________________
Authorized Representative (Printed):
Authorized Representative (Signature): __________________________________
Title: ____________________________________
Date: ____________________________________
This form and the Insurance Checklist must be completed and returned with Certificate of
Insurance, as specified, prior to contract award.
Insurance Guide - Prof. Lia.
Revised 3/17/2026

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