Insurance Agent (Broker) of Record Exhibit B - Proposer Information and Certification

Header InformationBid Number: S-R09145-00009897 Description: Insurance Agent (Broker) of Record Bid Opening Date: 04/24/2024 02:00:00 PM Purchaser: Justin Sweet Organization: Bend Park and Recreation District Department: R0914501 - Admin Services Location: 002 - Finance Fiscal Year: 25 Type Code: Allow Electronic Quote: No Alternate Id: Required Date: Available Date : 03/25/2024 09:34:17 AMInfo Contact: Bid Type: OPEN Informal Bid Flag: No Purchase Method: Open Market Pre Bid Conference: No Pre-Proposal meeting will be held for this RFP. Bulletin Desc: The District is seeking an insurance agent of record for property, casualty, workers compensation, and related lines of commercial insurance, and risk management consulting services. Prospective Proposers must offer policies through Special Districts Insurance Services and SAIF Corporation. Ship-to Address: Bill-to Address: Print Format: Bid Print New File Attachments: Request for Proposals Exhibit A - Proposal Checklist Exhibit B -

Proposer Information and Certification Exhibit C - Proposal Label Exhibit D - Sample Agreement Form Attachments: Required Quote Attachments Desired Attachment Name: Proposer Information and Certification Description: Exhibit B - Proposer Information and Certification Discipline Type: Personal Services Procurement Method: Competitive Sealed Proposal Item Information Item # 1: ( 953 - 00 ) Insurance Agent of Record Services NIGP Code: 953-00 INSURANCE AND INSURANCE SERVICES, ALL TYPES QtyUnit CostUOMTotal Discount Amt.Tax RateTax AmountTotal Cost 1.0 EA - Each Manufacturer: Brand: Model: Make: Packaging: Item # 2: ( 953 - 56 ) Insurance Agent of Record Services NIGP Code: 953-56 Liability Insurance, General QtyUnit CostUOMTotal Discount Amt.Tax RateTax AmountTotal Cost 1.0 EA - Each Manufacturer: Brand: Model: Make: Packaging: Item # 3: ( 953 - 92 ) Insurance Agent of Record Services NIGP Code: 953-92 Worker's Compensation QtyUnit CostUOMTotal Discount Amt.Tax RateTax AmountTotal Cost 1.0 EA - Each Manufacturer: Brand: Model: Make: Packaging: Item # 4: ( 953 - 77 ) Insurance Agent of Record Services NIGP Code: 953-77 Property and Casualty Insurance QtyUnit CostUOMTotal Discount Amt.Tax RateTax AmountTotal Cost 1.0 EA - Each Manufacturer: Brand: Model: Make: Packaging: