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VENDOR INFORMATION
Vendors Company Name (Full Legal Name): _________________________________
Owner/Supervisor Name: ______________________ Mobile #: ___________________
Vendors Business Phone #: ____________________ Fax#: _____________________
Vendors Business Email Address: __________________________________________
Contact Name & Number for Work Order Follow Up: ____________________________
Top of Form
W-9 Attached _______
Liability Certificate of Insurance Attached ______ Liability Insur. Expiration ___/___/__
Workers Comp Certificate of Insurance Attached ______ Expiration Date ___/___/___
Triangle Management, Inc. Named as Additional Insured _______
Applicable Licenses Attached _______
Vendor will maintain a commercial liability insurance policy in the minimum amount of $1,000,000, and such policy will be in effect as of the start of work and throughout the work, including any warranty period. Triangle Management, Inc. shall be included and named as an additional insured under this policy. Vendors commercial general liability insurance policy shall apply as primary insurance with respect to any other insurance available to or maintained by the Client and Triangle Management, Inc. Vendor agrees to provide Triangle Management with a copy of its Certificate of Insurance, and understands the Client may withhold payment if insurance lapses, until new insurance is in place.
Vendors Personnel authorized to sign on behalf of (Co. Name) ___________________
with respect to all contracts.
Printed Name and Title___________________________________________________
Signature _____________________________________________________________
List of Services Provided: ________________________________________________
References (Association/Property Mgr/Phone#) _______________________________
____________________________________________________________________
2682 White Oak Drive, Ann Arbor, Michigan 48103 734.585.5174 734.994.0467 (fax)
HYPERLINK "mailto:brucethomson@comcast.net" brucethomson@comcast.net HYPERLINK "http://www.trianglemgt.com" www.trianglemgt.com
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