*Please submit Minority Own certification if any (Section 3, MOB, WMOB, VOB, LGTBQOB, DBE, or other).
The service provider agrees to defend and indemnify BLDM. from liability associated with work performed as follows:
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Contactors providing service for BLDM. are required to carry current General Liability
Insurance at minimum $1,000,000 per occurrence and $2,000,000 aggregate
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BLDM LLC. must be named Additional Insured on the policy
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Service Providers agree to carry Worker's Compensation insurance or sign a waiver if not applicable.
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Contractors shall supply BLDM LLC. a copy of all such insurance documents as they may be amended, modified, canceled, terminated, or replaced.
Service Providers shall comply with all federal, state, and local laws relating to Worker's Compensation, Unemployment Compensation, and Social Security withholding.
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Please submit a copy of your Certificate of Liability Insurance, which identifies the following:
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Insurance Company Name
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Expiration Date of the Policy
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Dollar Limits
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BLDM, Inc. listed as Additional Insured
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BLDM, Inc. listed as a Certificate Holder
I certify that I am the sole owner/operator of the company listed above, and I do not have any employees. I will provide a certificate of Worker's Compensation Insurance to BLDM LLC. within 10 days of hiring any employees. Workers' Compensation includes employers' liability with minimum limits of $1,000,000 and includes a waiver of subrogation in favor of BLDM LLC
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