Vendors: Supplier Application (Other Suppliers)

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Valley Forge Contact Person:*

What products / Services does your company provide*

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On Site Services
Temp Employee
Production/Maintenance/Office/Shipping Supplies Fixed Assets
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Insurance Professional
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Freight Carrier

Products/Services Provided

What is the scope of all Products/Services:*

Relay additional information regarding raw materials, outside services, or resale only products.

Contact Information

Main Phone*

Sales Contact Name*

First Last

Sales Contact Phone*

Sales Email Address*

Accounts Recievable Contact*

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AR Contact Phone*

Accounts Receivable Email*

Terms

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Tax ID

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W-9

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Name of Certification*

Name*

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Insurance Requirements

We will update your file completely once we receive the insurance page from your named insurance company.

Valley Forge & Bolt MFG respectfully requests to be named as Additional Insured on your Certificate of Liability Insurance. The following coverage and language are required by our insurance carrier: Comprehensive General Liability insurance in the following amounts: General ..Aggregate $2,000,000 Products & Completed Operations ..Aggregate $2,000,000 Personal and ..Advertising Injury $1,000,000 Blanket Contractual Liability - Written and Oral $1,000,000 Fire Legal Liability $50,000 Each Occurrence $1,000,000 The policy shall include bodily injury, property damage, personal injury and broad form contractual liability coverage. The policy shall be endorsed to include: 1) the following additional insured language: "Valley Forge & Bolt MFG, its managing agent, and their respective officers, directors, shareholders, members, parent subsidiaries, related and affiliated entities and employees" shall be named as additional insured with respect to liability arising out of the activities performed by or on behalf of Valley Forge & Bolt MFG"; and 2) a waiver of subrogation against Valley Forge & Bolt MFG, its managing agent, and their respective officers, directors, shareholders, members, parent subsidiaries, related and affiliated entities and employees' for losses arising from work performed on behalf of Valley Forge & Bolt MFG. Automobile Liability in a Combined Single Limit (CLS) of $1,000,000.00. Bodily injury and property damage for any owned, hired and/ or non-owned vehicles used in the performance of this ..Agreement. The policy shall be endorsed to include the following additional insured language: ''Valley Forge & Bolt MFG, its managing agent, and their respective officers, directors, shareholders, members, parent subsidiaries, related and affiliated entities and employees" shall be named as additional insured with respect to liability arising out of the activities performed by or on behalf of Valley Forge & Bolt MFG, involving automobiles owned, leased, hired or borrowed. Workers Compensation shall provide all statutory Workers' Compensation Insurance coverage required in the states where contract services are to be performed. The policy shall be endorsed to include a waiver of subrogation against Valley Forge & Bolt MFG, its managing agent, and their respective officers, directors, shareholders, members, parent subsidiaries, related and affiliated entities and employees for losses arising from work performed on behalf of Valley Forge & Bolt MFG. Please also include evidence Excess Umbrella Liability minimum coverage of $1M

Name of Certificate*

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Products/Services Provided

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Valley Forge & Bolt

4410 W Jefferson St
Phoenix, AZ 85043
Toll Free: (800) 832-6587
Local: (602) 269-5748

Submit An Vendor Application

Products/Services Provided

Company Information

Contact Information

Terms

Insurance Requirements

Contact Us

XML Sitemap

HTML Sitemap

Valley Forge & Bolt

4410 W Jefferson St Phoenix, AZ 85043 Toll Free: (800) 832-6587 Local: (602) 269-5748

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4410 W Jefferson St
Phoenix, AZ 85043
Toll Free: (800) 832-6587
Local: (602) 269-5748