Vendor/Subcontractor Information Form

Date Submitted
Legal Business Name
D/B/A
Mailing Address
Physical Address
Phone Number
Fax Number
Contact Name
Federal ID#


Insurance Requirements:

Please furnish a Certificate of Insurance, satisfactory to the BLYTHE DEVELOPMENT, from each insurance company, showing the required insurance to be in force, and stating that the insurance shall not be canceled, non-renewed, or coverage be materially reduced except upon at least thirty (30) days written notice thereof to the BLYTHE DEVELOPMENT.

(1)  Worker’s Compensation Coverage as required by law, including statutory coverage for the state in which the Work is performed and the state of domicile of the SUBCONTRACTOR. SUBCONTRACTORS Worker’s Compensation coverage shall include Employer’s Liability with the following minimum limits:

$500,000 - Each Accident
$500,000 - Disease Each Employee
$500,000 - Disease Policy Limit

(2)  Commercial General Liability insurance with limits of a least $1,000,000 each occurrence for bodily injury and property damage liability, $1,000,000 each occurrence for Personal and Advertising Injury Liability, $2,000,000 General Aggregate and $2,000,000 Products and Completed Operations Aggregate. The General Aggregate Limit shall apply on a per project and per location basis. The BLYTHE DEVELOPMENT shall be named as an Additional Insured on the General Liability policy for both on-going and products and completed operations for a period of time equal to the statute of repose in the jurisdiction in which the work is performed. A copy of the Additional Insured endorsement(s) will be attached to the Certificate of Insurance. The coverage afforded to the BLYTHE DEVELOPMENT under the policy will apply on a primary and non-contributory basis. BLYTHE DEVELOPMENT shall be named as an additional insured as stated above as a condition to payment.

The coverage shall include; Bodily Injury/Property Damage, Products and Completed Operations, Broad Form Property Damage, XCU Hazards (Explosion, Collapse and Underground), Contractual Liability, Per Project General Aggregate Endorsement, and a Waiver of Subrogation in favor of the BLYTHE DEVELOPMENT. There should be no exclusion for Residential projects if the project covered by this Subcontract Agreement is deemed “Habitational” (i.e. apartments, condos, dorms, nursing homes, single-family dwellings).

(3)  Business Auto Liability shall be written to cover Hired, Non-Owned and all Owned vehicles with a minimum combined single limit of $1,000,000. BLYTHE DEVELOPMENT shall be named as an additional insured on the Automobile Liability Policy. The coverage afforded to the BLYTHE DEVELOPMENT under the policy will apply on a primary and non-contributory basis.

(4)  Umbrella Liability insurance with limits of at least $1,000,000 for each occurance with an annual aggregate of $1,000,000.

The Umbrella coverage shall apply on a following form basis covering Employer’s Liability, Comprehensive General Liability and Business Automobile Liability. The follow form provision will include the BLYTHE DEVELOPMENT as an Additional Insured and provide primary and non-contributory coverage as per the terms provided by the Commercial General Liability and Business Automobile Liability policies.

(5)  Professional Liability insurance with minimum limits of $1,000,000 each claim and $1,000,000 in the aggregate. In the event the SUBCONTRACTOR is a licensed architect or engineer and provides architectural, surveying or engineering services under this Subcontract Agreement, or in the event the SUBCONTRACTOR hires or engages a SECOND-TIER SUBCONTRACTOR to perform such services, Professional Liability insurance covering claims arising from real or alleged errors, omissions or negligent acts committed in the performance of its professional services is required. Coverage shall be maintained in effect for a period of time equal to the statute of repose in the jurisdiction in which the work is performed.

Each of the above policies will include a Waiver of Subrogation in favor of BLYTHE DEVELOPMENT.

The above insurance coverages are to be written through “A-“ or better-rated carrier(s) by the most current “Best Property & Casualty Rating Guide” and through carriers authorized to do business in the state or states in which the work is performed.